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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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Obama signs overhaul of how Medicare pays doctors.

2015 Medicare Physician Fee Schedule Update

Physicians Credentialing Doctors for Medicare Medicare News -April 15, 2015  CMS Provider Education Message Attention Health Professionals: Information Regarding the 2015 Medicare Physician Fee Schedule On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. Additionally, Medicare is also holding all therapy claims that would no longer qualify for the therapy cap exceptions (those therapy claims with the ‘KX’ modifier), due to the expiration of the therapy cap exceptions process on April 1, 2015.  In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update. Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received.  CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update. Providers [...]

By |April 18th, 2015|Commercial Insurance, Credentialing, Healthcare Professionals, Medicaid, Medical Credentialing, Medical Insurance, Medicare, Physician Credentialing|Comments Off on 2015 Medicare Physician Fee Schedule Update

Physician Credentialing Services

Physician Credential Services Credentialing with the government and commercial payers is challenging any way you slice it. Our job is to make this process as painless for you as possible. We take care of everything from start to finish and allow you to focus on other things. We offer physician credentialing services in all 50 states and have successfully credentialed hundreds of physicians over the years. Our team of experts understands the insurance companies but as former practice managers we also understand what these insurance contracts mean to your bottom line. We provide insurance credentialing services to Solo or Group Nurse Practitioners and Physician Assistants, Group Physicians, Solo Physicians, and Hospital Employed Providers. Our new physician credentialing services can include all or parts of the following: CAQH Registration Commercial Insurance Credentialing / Physician Credentialing (Overview of Credentialing Process Here) Managed Care & Government Payer Credentialing Workers Compensation Credentialing Medical License Application Processing & Tracking DEA Registration & Tracking NPI Registration (Type I & Type II) Individual Medicare Enrollment Medicare Enrollment for Group & Reassignment Commercial Insurance Contracting Payer Fee Schedule Creation & Evaluation Management of all Credentials What is Physician Credentialing? Physician Credentialing is often referred to as Primary Source Verification and is the Physician Credentialing process that hospitals, health plans and other facilities go through to verify the credentials of a particular physician. Physician Credentialing is also often used interchangeably to mean insurance enrollment, and that is what this page is all about. As a company, the Firm Services does not provide primary source verification services (verifying credentials), but we do credential hundreds of providers every year with insurance plans across the country. Whether it is Medicare, Medicaid, the various commercial insurance [...]

Medicare Payments Being Decided This Week by Congress

Credentialing Doctors for Medicare Mar 23, 2015 By Jane M. Orient, M.D. This week Congress will, for the 18th time, decide whether to cut doctors’ Medicare fees across the board, according to the Medicare Sustainable Growth Rate, “SGR”, formula (the Clinton-Gingrich sustainable growth rate). This was enacted in 1997 as part of the Balanced Budget Act. It has been postponed 17 times because of the threat that seniors would lose access to medical care. And with each delay, the threatened future cut gets bigger. On March 31, the cut will be 21%, if it happens. Since doctors’ expenses consume at least half of what comes in, that would mean a cut of at least 50% in doctors’ pay. Some would lose money every time they saw a Medicare patient. Every year there’s a call for a permanent “doc fix,” a “repeal and replace.” It could happen this year, with a bipartisan Boehner-Pelosi scheme. This would also cut the number of services rendered to Medicare patients, but it would supposedly make things better because we’d be paying for “value, not volume.” The Medicare bureaucracy would determine value. “Alternate payment models” involve things like practice improvement activities, population management, care coordination, and beneficiary engagement. These require a lot of electronic data collection on “quality metrics.” Independent doctors probably can’t figure out how to do all these new tasks. But getting rid of such doctors, and fee-for-service payment, is part of the plan. The theory is that if doctors get paid more when patients stay healthy, and lose money on treating the sick, this new incentive structure will result in both better health and less spending. End-of-life counseling—guiding patients’ decisions on what care they don’t want [...]

By |April 3rd, 2015|Medical Credentialing, Medical Insurance, Medicare|Comments Off on Medicare Payments Being Decided This Week by Congress