FAQs

Frequently Asked Questions

Over the years, we have received quite a few questions regarding the service we offer and the mechanics of how we provide that service. This page is designed to help answer some of those questions for you. If your question is not answered here, feel free to Contact Us.


Which specialties do you work with?
We work with most specialties. While the list below is not an exhaustive one, it does include most of the specialties we work with.

What medical specialties do you exclude?
Since MBA is committed to offering a high quality service, we do not accept providers from all specialties. Just as one provider cannot specialize in everything, MBA cannot either. For that reason, we do not offer our service to providers in the following specialties:

Ambulance Services DME
Suppliers (Drug stores, etc)
Podiatry
Speech and Language Therapy
Anesthesia


What is Precision Claim Technology?
Precision Claim Technology is a proprietary claim-checking methodology. MBA believes that one should rely on human intervention as little as possible when it comes to checking claims for correctness. Since we began, MBA has been developing and refining this technology to adapt to changes in the healthcare and insurance industry. After a claim is entered into our system, it is checked against hundreds of possible data entry errors. Below are just a few of the items we automatically check:

• Is the date of service after the patient's date of birth?
• Does the date of service precede today?
• Does the CPT code entered correlate with the place of service? Is the CPT Code valid for the date of service?
• Is the ICD-9 Code valid for the date of service?

And only about 100 other checks.... can your software protect against these?

Our software then checks to see if the procedures entered have a Local Medical Review Policy (LMRP) or National Coverage Decision (NCD) and checks CPT codes against the Correct Coding Initiative (CCI) for bundling and un-bundling errors and automatically adds the appropriate modifiers. If an error is found, the claim is sent back to you for correction or more specificity.

What does all this mean to you? It means you get paid for the work you do! No longer will you get denials back because the procedure you performed doesn't have a supporting diagnosis or is bundled with another procedure performed on that day.

Where do claims go when they are filed electronically?
MBA's approach to filing claims is quite different than other vendors. We do not file every claim with a clearinghouse allow them to assume responsibility. We believe a claim should go through as few steps as possible to reach it's final destination. That is why we file directly with the following carriers: NC Medicare (Cigna Part B), NC Medicaid (EDS), BCBS, NC Palmetto GBA (DME), Riverbend GBA (Rural Health Care Medicare), and WebMD Transaction Services (formerly known as NEIC/Envoy). All commercial claims that can be filed electronically are submitted to WebMD Transaction Services. This is the only "clearinghouse" from which many large insurance companies will accept claims (United Health Care, Aetna, etc.). Most clearinghouses eventually send their claims to WebMD Transaction Services. Not all insurance companies will accept claims electronically. For those companies, MBA submits laser printed HCFA 1500 claim forms.

What does MBA need from me?
Our goal is to seamlessly provide our services to you. If you are using the Bronze service, you simply need to furnish MBA with the patient's demographics (one-time) and a copy of your super-bill or encounter form with the following information on it: - Patient Name - Date of Service - Diagnosis (can be free text) - Procedures and charges - Place of service. Since MBA provides services for a large number of providers throughout the state, we also require an additional form of identification which can be any one of the following: - Your internal account number - Patient date of birth - Medicare ID# or Medicaid ID#. After you receive EOB's from the insurance companies, we ask that your office forward them to our office for posting. This allows us to follow-up on any claim that has not been responded to by the insurance companies.

Does MBA have access to my bank account?
ABSOLUTELY NOT. We do not have signature rights to your bank account. Federal Law prohibits us from having access to your bank account. If you choose either the Silver or Gold Service Level, we can only deposit checks for you. Any time a refund check is needed for either insurance companies or patients, we send the request (or check) to you for signature.

Can I still have the checks come directly to me?
We do not strictly prohibit this, but we do recommend against it. Every claim that is filed starts a critical timing process. If you desire to see the EOB's, we recommend using our EOB-2-PDF service, which allows you to receive all EOB's in a searchable PDF format. This allows us to get the EOB's as fast as possible to post the patients account, but still gives you access to your EOB's, without the hassle of maintaining EOB files.

Will you call my patients if they don't pay their bill?
The Gold service is designed to encourage patients to pay their bills by contacting them if they do not respond in some way to our statements. We have found that patients have become conditioned to ignoring bills from medical practices because of the patient billing methods utilized by other medical offices. Our approach is to contact the patient to confirm that we have filed all applicable insurance for them. If we have, we explain how we arrived at their balance and try to work with them to establish timely payment of their outstanding balances.

Do you offer collections services?
No. We view this as a conflict of interest for MBA. After we have exhausted our efforts to collect unpaid balances from patients, we will generate a collections notice and send it to you or your office manager. From that point, you can either forward it to your preferred collection agency, contact your patient, or ignore it. From MBA's perspective, the patient's balance is $0. If you do send the claim to a collection agency and they are able to collect the balance, we remove the collections write-off and post the patient's payment. If you do not have a collection agency working for you, MBA can provide you with recommendations based on our experience.

Is MBA using any of the ANSI standards?
Yes. We are currently using several ANSI X12N 837 standards. We have been certified for 4010A1 with several carriers and are currently testing with other carriers that allow the 4010 at this time. We can also accept the ANSI X12N 835.4010A1 for electronic remittance advices for select carriers.

How is Net Revenue Calculated?
For service levels billed on a percentage of Net Revenue, it is important to understand how this is calculated. MBA follows industry guidelines for Net Revenue, which is defined as Gross Revenue (all revenue posted during the reporting month) minus all refunds posted during the current month minus monies received from a collection agency.

Are there any contracts?
Yes. We ask that you give us one full year to demonstrate the benefits of our service to you. If you wish to terminate within the first year for reasons that are not related to the quality and performance of our service, early termination fees may apply. To date, we have never had any client to terminate their contract!

Are there any initial fees or hidden costs?
No. There is no initial fee. The fees are just what we quote. We aim to keep things as simple as possible. We do not bill separately for appeals or the re-filing of claims. Depending on your service level, you are billed once for a procedure or encounter (Bronze Service) or you are billed based on the net revenue collected during the reporting period (Silver & Gold Service).

Is MBA HIPAA Compliant?
This question cannot be answered with a simple yes or no. HIPAA encompasses many different regulations, each of which has its own deadlines. The only regulations currently in effect are the Transaction and Code Sets for electronic claim submission and patient privacy. MBA is currently able to submit claims electronically in the HIPAA mandated ANSI X12 837 v4010A1. We are also able to receive the ANSI X12 835 v4010A1.