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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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End Of Medicare Bonuses Will Cut Pay To Primary Care Doctors

HEALTH INC. November 28, 2015-7:03 AM ET : Michelle Andrews Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all. The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 report by the Medicare Payment Advisory Commission. Although that may sound like a small adjustment, it can be important to a primary care practice, says Dr. Wanda Filer, president of the American Academy of Family Physicians. "It's not so much about the salary as it's about the practice expense," she explains. "Family medicine runs on very small margins, and sometimes on negative margins if they're paying for electronic health records, for example. Every few thousand makes a difference." Doctors in family medicine, internal medicine and geriatrics are eligible for the bonuses, as are nurse practitioners and physician assistants. Medicare generally pays lower fees for primary care visits to evaluate and coordinate patients' care than for procedures that specialists perform. The difference is reflected in physician salaries. Half of primary care physicians made less than $241,000 in 2014, while for specialists the halfway mark [...]

Why are Incorrect Characters a Top ICD-10 Coding Challenge?

Rev Cycle Intelligence- By Jacqueline DiChiara on November 17, 2015 “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant." Lack of training for inpatient procedural coding may pose a significant challenge for the healthcare industry as 2015 comes to a close, said Teri Jorwic, ICD-10 Educator and Professor of Healthcare Informatics at the University of Illinois at Chicago, to RevCycleIntelligence.com in an exclusive interview last September. icd-10-cm coding characters Jorwic caught up once again with RevCycleIntelligence.com to assess what has been happening across the greater healthcare space in regard to procedural coding concerns over the past month and a half. “The two main things I’ve heard so far have to do with either linking and LCDs [Local Coverage Determination] or NCDs [National Coverage Determination], particularly having to do with the injury codes and the seven characters,” Jorwic states. Questions about whether or not the coverage is the same post-October 1, 2015 are common, says Jorwic, who confirms coverage policy changes are on the horizon. “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant,” she says. Physical therapists, for instance, may struggle to determine differences between “initial” and “sequela,” as they often deal with a subsequent portion of injury when a patient enters regular recovery. Another problem now popping up involves new guidelines for the often perplexing Excludes1 notes, says Jorwic. “There is a new guideline in ICD-10-CM – the diagnoses side that says if you have an Excludes1 note, you cannot code conditions that appear in that Excludes1 notation together,” says Jorwic. “So, the classic example would be, for example, a patient that [...]

How to improve queries for ICD-10 claims

by CARL NATALE  OCT 28, 2015 - 05:51 AM U.S. healthcare is waiting to see how ICD-10 implementation affects reimbursements. The fear is that ICD-10 claims will be denied at a greater rate than before Oct. 1 — either by design or error. And that is going to trickle down to physicians in the form of queries. And if a medical practice wants to avoid an increase in denials, it needs to help physicians provide more clinical detail to support the proper ICD-10 codes. That will most likely come in the form of queries. Do you really need to query? But medical coders need to make sure they really need to query. Pamela Haney lists four tests of whether an ICD-10 query is needed: Does the medical record contain conflicting information? Are there elements or information missing from the medical record? Are there conditions or procedures that need more detail to support a specific ICD-10 code? If there is an unspecified diagnosis, is there information that suggests a more specific diagnosis is possible? The Journal of AHIMA published guidelines that explain writing a query is needed when clinical documentation: "Is conflicting, imprecise, incomplete, illegible, ambiguous or inconsistent" Describes clinical indicators that don't clearly support the underlying diagnosis Includes clinical indicators, evaluation, and/or treatment that does not seem related to any medical condition or procedure Does not support or validate a diagnosis Does not support the present on admission indicator If you have to query Review some quidelines on how to write better queries for information that supports ICD-10 coding: Be written in clear, concise and precise language Contain evidence specific to the case Be non-leading Be part of the clinical documentation Include ICD-10 language But [...]