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Terms and Conditions
These Terms and Conditions govern the provision of mobile dysphagia diagnostic services, including Modified Barium Swallow Studies (MBSS/VFSS), by MBS Imaging, LLC (“MBS Imaging,” “Company,” “we,” “us,” or “our”) to healthcare facilities, providers, patients, and authorized representatives (“Client,” “Facility,” “you,” or “your”). These terms are intended to outline service expectations, documentation requirements, payment responsibilities, privacy obligations, and operational procedures.
Services Provided
MBS Imaging provides mobile diagnostic services related to swallowing disorders, including Modified Barium Swallow Studies, also known as Video Fluoroscopic Swallow Studies. Services may include on-site imaging, speech-language pathology evaluation, physician supervision or interpretation when applicable, clinical documentation, imaging access, and related recommendations for dysphagia management.
Services are provided only when medically appropriate and supported by required clinical documentation, including a valid physician order and patient authorization or consent when required.
Referral and Scheduling Requirements
Before a study can be scheduled or performed, the referring Facility or provider must submit all required referral materials, which may include the patient face sheet, signed physician order, diagnosis or reason for study, insurance information, authorization or consent forms, relevant clinical swallow evaluation, current diet information, medication list, isolation precautions, mobility status, and any special clinical needs.
MBS Imaging may decline, delay, or reschedule a study if required documentation is incomplete, the patient is unavailable, the patient’s condition is unsafe for testing, the Facility cannot provide necessary access or support, or insurance/authorization requirements have not been satisfied.
Facility Responsibilities
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Provide safe and timely access to the patient, chart, clinical information, and appropriate Facility staff.
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Ensure that a valid physician order and required authorization or consent are obtained before the study.
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Notify MBS Imaging of isolation precautions, patient mobility limitations, cognitive or behavioral concerns, tracheostomy or ventilator status, allergies, and any relevant medical changes.
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Provide adequate parking and safe access for mobile equipment when services are performed on-site.
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Make appropriate clinical support available when required, including nursing support or respiratory therapy for patients with special needs.
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Maintain responsibility for ongoing patient care, implementation of recommendations, diet orders, and physician follow-up.
Patient Consent and Clinical Limitations
The patient, legal representative, or authorized decision-maker must provide consent when required by law, payer rules, or Facility policy. If the patient is unable or unwilling to participate safely, MBS Imaging may postpone or discontinue the study.
MBSS/VFSS results are based on the patient’s condition and performance at the time of testing. Recommendations are clinical guidance and do not replace the judgment of the treating physician, Facility care team, or other licensed providers responsible for the patient’s care plan.
Reports, Imaging, and Records
MBS Imaging will provide reports, imaging access, and related documentation according to its standard procedures and applicable legal, payer, and Facility requirements. Reports and images are intended for authorized clinical use only and may not be copied, distributed, or disclosed except as permitted by law and applicable agreements.
Billing and Payment
Billing may be submitted to Medicare, Medicaid, commercial insurance, the Facility, the patient, or another responsible party depending on coverage, payer requirements, contractual arrangements, and applicable law. The Facility or referring party is responsible for providing complete and accurate insurance and billing information before the date of service.
If a claim is denied due to missing, inaccurate, or delayed information supplied by the Facility or responsible party, the Facility or responsible party may be responsible for payment to the extent permitted by law and any applicable agreement. Patient financial responsibility, if any, will be handled in accordance with payer rules and applicable healthcare billing laws.
Cancellations, Delays, and Access Issues
The Facility should notify MBS Imaging as soon as possible if a scheduled patient is unavailable, hospitalized, discharged, in isolation, medically unstable, or otherwise unable to participate. MBS Imaging may reschedule services due to weather, equipment issues, staffing, incomplete documentation, safety concerns, or circumstances beyond reasonable control.
Privacy, HIPAA, and Confidentiality
MBS Imaging handles protected health information in accordance with applicable federal and state privacy laws, including HIPAA, and will use or disclose patient information only as permitted for treatment, payment, healthcare operations, patient authorization, or as otherwise required or permitted by law.
The Facility agrees to safeguard patient information, share only the minimum necessary information needed for service coordination, and promptly notify MBS Imaging of any privacy or security concern involving records, reports, images, or communications related to MBS Imaging services.
Compliance With Laws and Professional Standards
Each party agrees to comply with applicable federal, state, and local laws, regulations, payer requirements, professional standards, licensing requirements, and Facility policies related to the services. MBS Imaging personnel will maintain appropriate credentials, training, and professional qualifications for services they perform.
Limitation of Responsibility
MBS Imaging is responsible for performing the requested diagnostic service within the scope of the referral and applicable professional standards. The Facility and treating providers remain responsible for patient monitoring, medication administration, diet implementation, treatment decisions, emergency response, and ongoing clinical care before, during, and after the study.
Insurance and Authorization
Insurance coverage and prior authorization requirements vary by payer. Submission of a referral does not guarantee coverage or payment. The Facility or referring provider must assist with payer documentation, medical necessity support, and requested records when needed.
Termination or Refusal of Services
MBS Imaging may refuse, suspend, or terminate services if documentation is incomplete, payment terms are not met, unsafe conditions exist, patient care requirements cannot be supported, Facility cooperation is insufficient, or continued service would violate law, payer rules, professional standards, or patient safety expectations.
Acceptance
By submitting a referral, scheduling services, allowing MBS Imaging to provide services on-site, or signing below, the Facility, provider, patient, or authorized representative acknowledges and agrees to these Terms and Conditions.