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Summary of Services

The FIRM provides professional claims billing services for individual providers, clinics and facilities. We service all disciplines of practice, i.e., medical, dental, diagnostic testing, chiropractic, physical therapy, optometry/ophthalmology, mental health, chemical dependency, and durable medical equipment.

We offer specialty services such as consultation, collections and appeals, contracting and credentialing, verification and preauthorization and personal injury settlement negotiating. We offer form development and revision services, office reorganization and personnel training.

We have extensive experience in all areas of commercial insurance, Workers Compensation, personal injury, Third Party Administrators, Medicare, Medicaid, and other state and federally funded programs. We offer personalized services designed specifically to meet your needs.

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Modernizing Medicare with the QPP

Let the Experts at The Firm Services assist your practice. HBMA- Dr. Kate Goodrich- 03/13/2017 Modernizing Medicare with the QPP Keeping Medicare’s Promise to Families Today and Tomorrow By Kate Goodrich, Centers for Medicare & Medicare Services (CMS), US Department of Health and Human Services (HHS) Billing managers are uniquely positioned to support clinicians in succeeding under the new program. For example, you can assist physician and other clinical practices in: Determining whether they need to participate in the Quality Payment Program (QPP); Verifying whether they meet desired thresholds in terms of Medicare fee-for-service (FFS) patient counts and billing amounts; Examining the potential impact of various participation options on revenue; and Analyzing CMS feedback on cost performance measures. And, for clinicians who don’t believe they’re prepared to participate, you can help them understand that CMS offers flexible options. We understand that resources and technology vary widely across practices, and we want the broadest participation possible among eligible clinicians. I look forward to continuing to work with the entire healthcare community as we embark on the implementation of the QPP. Background In October 2016, HHS launched the QPP with a final rule with comment period implementing certain provisions of MACRA – the Medicare Access and CHIP Reauthorization Act of 2015. A bipartisan solution, MACRA ended the flawed Sustainable Growth Rate (SGR) formula for Physician Fee Schedule payments, and streamlined existing Medicare quality reporting programs. MACRA was enacted to strengthen Medicare. Clinicians who participate in Medicare are part of a dedicated team that serves 55 million of our country’s most vulnerable Americans. As a result of the SGR formula, physicians and other clinical practices faced payment cliffs for 13 years. The QPP improves Medicare by [...]

Donald Trump’s promises are taking a beating in the GOP’s Obamacare replacement

Questions? Call the Professionals at The Firm Services. Washington Post - By Aaron Blake March 10 at 10:29 AM Two big stories on the Republicans' Obamacare replacement bill broke late Thursday. And both point to major broken promises for President Trump. The Washington Post's Katie Zezima and Christopher Ingraham report that the bill would cut a mental-health and addiction treatment mandate covering 1.3 million Americans — counter to a Trump promise to expand treatment: The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide. Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans. CNN, meanwhile, is reporting that the Trump White House is negotiating to possibly roll back the Medicaid expansion earlier to appeal to conservatives — counter to Trump's promise to leave Medicaid alone: White House officials are beginning to urge House GOP leadership to include an earlier sunset of the Medicaid expansion funds authorized under Obamacare than the 2020 date set by the current bill. The change comes just days after the bill was unveiled and follows a blitz of activism aimed squarely at the White House and President Donald Trump, who has met with conservative leaders in recent days. Here's what Trump said last year: “I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid.” After House Republicans released a proposal to transform the Affordable Care Act, members of [...]

The Advantages and Disadvantages of Electronic Medical Records

Credentialing, Revalidation Services professionals at The Firm Services Crystal Lombardo- The Next Galaxy  The advancement of technology has changed the way the entire world functions. One big change that has happened has to do with the medical world. Electronic medical records, or EMR’s, are used in just about every single hospital and doctor’s office in the United States. Electronic medical record means that a patient’s paper chart, which is what contains all of their medical history, information on medical conditions, treatments, and other types of information, are all stored electronically. It has been a great asset to the medical community, but has brought some pretty hefty issues right along with it. Advantages of Electronic Medical Records 1. Instant Access is an Advantage EMR give medical professionals quick and simple access to all of the patient information that they may need in order to provide an accurate and speedy diagnosis. Much of the confusion, and bureaucratic characteristics of the medical world are eliminated with the use of electronic medical records. 2. Doctor’s Have Bad Handwriting It is no secret that the majority of doctors have pretty illegible penmanship. This has been a problem that has haunted the medical world for decades. Electronic medical records have solved this problem! Doctors no longer have to scribble notes that may not be able to be read, instead they type them into the electronic medical record database, so there is never anymore confusion about if that is an “r” or a “z”. 3. Record Keeping Has Been Cleaned Up Keeping a physical record for each patient can begin to take up a pretty intense amount of space. Boxes and boxes of records are filed in order to be [...]

Trump urges insurers to work together to ‘save Americans from Obamacare’

Will Obamacare survive? Washington Post - By Carolyn Y. Johnson and Juliet Eilperin February 27 at 12:19 PM  President Trump met with major health insurers Monday morning, in the midst of political divisions over how to dismantle and replace President Obama's signature health-care law, the Affordable Care Act, and intensifying public pressure to preserve the policy. The meeting included leaders from Blue Cross Blue Shield, Cigna, Humana, UnitedHealth Group, Aetna, Anthem, Kaiser Permanente and the industry lobbying group, America's Health Insurance Plans. "We must work together to save Americans from Obamacare," Trump said in public remarks before the closed-door meeting. He criticized the Affordable Care Act, commonly known as Obamacare, for creating minimal health coverage requirements that restricted the types of plans insurers could sell. "Obamacare forced providers to limit the plan options they offered to patients and caused them to drive prices way up," Trump said. "Now a third of U.S. counties are down to one insurer, and the insurers are fleeing. You people know that better than anybody." Over the past month, more insurers have warned that they could pull out of the Affordable Care Act’s health-care exchanges where individuals can buy government-subsidized insurance. Aetna chief executive Mark Bertolini has described the exchanges as being in a "death spiral." Humana — which insures about 150,000 people on the exchanges this year — announced in mid-February it would exit the exchanges in 2018. In an earnings call, Molina Healthcare disclosed that its exchange business lost $110 million in 2016 and said it would evaluate its participation for next year on a state-by-state basis. A Molina spokeswoman said the company, which insures 1 million members through the exchanges, was not invited to the meeting. Trump gave [...]

The Trump administration just proposed big changes to Obamacare

Will Obamacare survive? Business Insider- Feb. 15, 2017, 9:54 AM- Bob Bryan The Centers for Medicare and Medicaid Services on Wednesday morning announced new proposed rules for the Affordable Care Act's individual insurance exchanges. The proposals from CMS include several changes to enrollment periods and timelines for insurers in an attempt at "stabilizing the individual and small group health insurance markets," according to a press release. The proposed changes would be the first administrative tweaks to the law, also known as Obamacare, under President Donald Trump's administration. They contain a combination of long-considered ideas and serious departures from the previous administration. Perhaps the two most striking proposed changes are cutting in half the exchanges' 2018 open enrollment period and lowering minimum standards for care to qualify for the exchanges. The CMS proposes an open enrollment period — during which people without health insurance through their employer or Medicaid/Medicare can sign up for coverage — from November 1 to December 15, 2017. Open enrollment periods have been three months, from November 1 to January 31. Additionally, the rules would lower the "de minimis range used for determining the level of coverage," according to the release. Essentially, the ACA established minimum standards for coverage (here's a full breakdown from CMS) in order to be certified on the bronze, silver, and gold plan levels. The new rule would allow insurers to cover slightly fewer areas of health and still be at a certain metal level. The CMS projects the rules would result in increased out-of-pocket costs for Americans in the short term but that lower premiums would offset this in the long run. "The proposed change in [actuarial value] could reduce the value of coverage for [...]

As Obamacare Repeal Stalls, Republicans Face New Challenges

Will Obamacare survive? NBC News - Benjy Sarlin -FEB 8 2017, 9:55 AM ET President Donald Trump caused a stir when he suggested Sunday that the Republican Party's quest to repeal and replace the Affordable Care Act might continue through 2018. But some Republicans think he might be on to something. "I know there was some hyperventilating about the president's comments that this could spill into next year, but that didn't bother me," Rep. Charlie Dent, R-Pennsylvania, said as he left a caucus meeting Tuesday. "I thought it was fairly realistic." "I do think slowing down would be wise," Rep. Tom MacArthur, R-New Jersey, told NBC News when asked about Trump's comments. Trump's remarks come as efforts to repeal and replace the Affordable Care Act, which began with a bang after the election, are lagging amid internal debates over the substance of a Republican health care plan and the process used to pass it. The current plan is a delicate multi-step path that requires Republicans to use the budget reconciliation process to partly repeal Obamacare by a majority vote and install some elements of a Republican plan, then negotiate with Democrats later on a full replacement, which would require 60 Senate votes. Republicans can't manage many defections — they have only 52 votes in the Senate — and consensus has so far been elusive. On one hand, conservatives are eager to fulfill the Republican Party's longtime promise to repeal the law and replace it with a less expensive plan with fewer taxes and more free-market principles. On the other hand, more moderate Republicans are concerned that removing too much of the law too fast could wreck the insurance market and that some conservative [...]

Doctors Make the Case for Obamacare or Something Like It

Will Obamacare survive? NBC News -HEALTH- Maggie Fox -FEB 2 2017, 6:20 PM ET Congress should improve Obamacare without taking away what's best about it, doctors said Thursday. Doctors who treat women and children, as well as general practitioners, made a daylong dive across Senate offices to make the case for keeping important aspects of the Affordable Care Act. And they rebuked Republicans in Congress for talking up repeal without having a plan for replacement in place. "Currently insured individuals should not lose their coverage as a result of any action or inaction by policymakers," five medical organizations said in a statement released as part of the lobbying push. "Acceptable reform must continue to ensure access to comprehensive, safe, and affordable care," said Dr. Thomas Gellhaus, president of the American Congress of Obstetricians and Gynecologists. The GOP has vowed to repeal and replace the 2010 Affordable Care Act, former president Barack Obama's signature policy. But since they took firmer control of the Senate, kept control of the House and seated Republican President Donald Trump in the White House, they've faltered, quarreling about how to move ahead. “Potential changes in federal Medicaid funding should not erode benefits, eligibility, or coverage compared to current law.” It doesn't help that the law's become more popular in the polls. Republicans do not want to pull the rug out from under the 20 million people who have gotten health insurance under the law, either on the exchanges where they can buy private insurance, often with a federal subsidy, or through expansions of the Medicaid program. "We didn't hear from anyone who said we want to have the 20 million people who have gained coverage under the Affordable Care [...]

Showing panic over Obamacare repeal, GOP senators release replacement plan that (almost) makes sense

Will Obamacare survive? LA Times - Michael Hiltzik - January 24,2017 2;25pm If you’re following the health insurance debate—and since the coverage of more than 20 million Americans is under threat from the Trump White House and the Republican congressional majority, you should be—you’re going to be hearing a lot in the coming weeks about Cassidy-Collins. That’s an Obamacare replacement plan just introduced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine). Dubbed the Patient Freedom Act, It’s the first such proposal that indicates that the GOP is becoming increasingly panicked about the political price of repealing the Affordable Care Act outright, and increasingly desperate to reassure voters that the provisions of Obamacare they actually value can be retained without a break. These include Obamacare’s protection of coverage for pre-existing conditions, its ban on lifetime and annual limits for benefits, and coverage of certain preventive services without co-pays. It also keeps coverage of mental health services and guarantees black-lung benefits for coal miners. The federal exchange, healthcare.gov, will continue to operate. Dependents still will be permitted to stay on their parents’ employer-sponsored plans until age 26. The measure kills the employer mandate and individual mandate, though it substitutes a “continuous coverage” system for the latter, which we’ll explain in a bit. The other [Republican] bills have said, Let’s just get rid of Obamacare. This one seems to be offering options. — Karen Pollitz, Kaiser Family Foundation The goal of Cassidy-Collins is to shift the the decision of whether to keep Obamacare, dump it entirely, or come up with an alternative system to the states. (A three-page section-by-section summary is here.) “When you speak to Americans,” Cassidy said Monday on the Senate floor, “they [...]

How Large Employer Health Plans Could Be Affected By Obamacare Overhaul

Will Obamacare survive? Kaiser Health News- January 19, 2017 5:00 AM ET MICHELLE ANDREWS If you think that you wouldn't be touched by a Republican overhaul of Obamacare because you get health insurance through your job at a big company, think again. Several of the law's provisions apply to plans offered by large employers, too (with some exceptions for plans that were in place before the law passed in March 2010). It's not yet clear how President-elect Donald Trump and congressional Republicans plan to revamp the federal health law, known as the Affordable Care Act or Obamacare. They have not agreed on a plan, and they do not have enough votes in the Senate to fully repeal the current statute. So they are planning to use a budgeting rule to disassemble part of the law, which will limit what they can change. But they also may seek revisions in important regulations and guidance that have determined how the law is implemented. Nonetheless, as tensions grow in Washington over the future of the health law, it is important to understand some of its effects on large-group plans. No copays for preventive services The health insurance offered by big companies is typically pretty comprehensive, the better to attract and keep good employees. But Obamacare broadened some coverage requirements. Under the law, insurers and employers have to cover many preventive services without charging people anything for them. The services that are required with no out-of-pocket payments include dozens of screenings and tests, including mammograms and colonoscopies that are recommended by the U.S. Preventive Services Task Force; routine immunizations endorsed by the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices; and a range of [...]

Senate Takes First Step To Repeal Obamacare — So What’s Next?

Will Obamacare survive? NPR -January 12, 20175:04 AM ET Heard on Morning Edition - Danielle Kurtzleben / Alisa Chang -With reporting from Susan Davis. At about 1:30 a.m. on Thursday, Republicans moved one step closer to repealing a law they have railed against since the moment it was passed nearly seven years ago. By a final vote of 51-48, the Senate approved a budget resolution that sets the stage for broad swaths of the Affordable Care Act to be repealed through a process known as budget reconciliation. The resolution now goes to the House, where leaders are hoping to approve it by the end of the week. The powerful tool sets up a fast track for repealing large parts of Barack Obama's major domestic achievement; the best guess is that the Senate is still several weeks away from largely repealing Obamacare. But as the process continues, large questions still loom over how — and when – Republicans will replace the health care law. An expedited repeal, starting with a vote-a-rama The vote took place during a session known as a "vote-a-rama." These all-night vote-fests happen surrounding budget resolutions, which allow senators to propose unlimited amendments, as the New York Times' Thomas Kaplan explained this week. The passage of the resolution kicks off the budget reconciliation process. That process is special because a reconciliation measure cannot be filibustered, meaning it allows the Senate to pass a bill with a simple majority (as opposed to needing 60 votes to overcome a filibuster). That's good for Republicans, who hold 52 of the Senate's 100 seats. Once the House approves the measure, which could happen as soon as Friday, committees from both chambers will meet to create [...]