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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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Keeping up with ICD-10 education

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE ABYSS December 18, 2015 By Avery Hurt Many providers and coders are just getting into the ICD-10 groove, but staying there requires a little bit of ongoing training. For coders this means keeping up their certification. What many coders might not be aware of, however, is that time is running out. Most coders must complete a proficiency test or complete certain continuing education credits by Dec. 31, 2015. Otherwise they will lose their credentialing. Providers need to do a little continuing education as well if they want to stay on top of ICD-10. "Every now and then you need to look to make sure you are using the most specific code," suggested Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians. You don't want to fall into a rut of using the same codes when better ones are available. CMS is going easy on non-specific codes for the first 12 months of ICD-10, but next October will come before you know it. And private payers are expected to start tightening up sooner than that. At the moment, very few claims are being denied on the basis of diagnosis codes, but some experts have started to see a slight uptick in these denials. If you're not already using the most appropriate codes available, make sure you start soon, even if that means an ICD-10 refresher course. Hays said she didn't expect to see much in the way of significant policy changes from payers, but the codes themselves will be adjusted and refined on an ongoing basis. CMS will publish yearly updates to the ICD-10 codes—the flexibility to change as medical science [...]

The Definitive ICD-10 Guide to Holiday Movies

Santa's Healthy Heart! His new ICD-10 coded screening. Written by  Wendy Aiken, PMI-ACP | Monday, 14 December 2015 00:00 We all have one: a beloved holiday flick that inspires us to deck the halls, snuggle up, and press play. Whether you’re a die-hard fan of a Christmas classic, or you prefer the elven shenanigans of Will Ferrell, here’s one holiday treat everyone should enjoy: the coder’s complete ICD-10 list for holiday films. National Lampoon’s Christmas Vacation (1989) Clark Griswold, our favorite overly optimistic father, is no doubt a Christmas movie legend. Despite his high hopes for the perfect family Christmas, he gets more than his fair share of merry misfortune. Blame it on his questionable light-hanging practices, extreme sled-riding, and obsession with that Christmas bonus (for a pool, of course). T75.4XXA Electrocution, initial encounter V00.221A Fall from sled, initial encounter W16.0 Fall into swimming pool It’s a Wonderful Life (1946) After George Bailey, a failing businessman, crashes his car into a tree, he wishes he’d never been born. But a guardian angel shows him that the world would be a grim place if he didn’t exist, and George realizes he really does have a wonderful life. V47 Car occupant injured in collision with fixed or stationary object F33.4 Major depressive disorder, recurrent, in remission R42 Dizziness and giddiness A Christmas Story (1983) Poor Ralphie endures a suspenseful holiday season pining for an official Red Ryder, carbine-action, 200-shot range model BB gun. His friend, meanwhile, learns an ice-covered flagpole can leave you tongue-tied, and Ralphie’s father grieves the loss of his precious leg lamp. W34.118A Accidental malfunction of other gas, air, or spring-operated gun Q38.1 Ankyloglossia (tongue-tied) S82.301A Fracture of lower leg, initial encounter for [...]

NCDs and LCDs Hit Hardest by ICD-10

ICD-10 update from physician practices By Beth Friedman, BSHA, RHIT, president and founder of Agency Ten22 Posted on: December 11, 2015 Despite physician resistance, the transition to ICD-10 has gone relatively smoothly for most physician practices. However, we've also heard the buzz that orthopedic and radiology practices may be facing some challenges related to specificity and medical necessity. Since ICD-10 codes are needed to prove medical necessity in medical group settings, this comes as no surprise to health information and IT professionals. Three coding experts chimed in this week about ICD-10 challenges witnessed at the 60-day mark of ICD-10 implementation. Following is a summary of their experiences to date: Kelly Whittle, MS, principal at ICD-10 Advisory and Whittle Advisors, LLC says confusion and technical glitches with Local Carrier Determinations (LCDs) and National Coverage Determinations (NCDs) are the biggest challenge in physician practices to date. Notably, in mid-November, CMS published a clarification about LCD and NCD updates. Regarding NCD errors, CMS states: "CMS is committed to resolving these small isolated issues quickly to ensure that claims continue to process. Interim solutions are currently in place to permit appropriate and timely claims payment. In most cases, claims inappropriately rejected or denied have been automatically reprocessed and no action is required by the provider." Regarding LCD errors, CMS says: "Once ICD-10 was implemented, some MACs identified LCDs for which they needed to further refine their edits to add allowable ICD-10 diagnosis codes. In general, claims affected by these edits with dates of service on and after October 1, 2015 were suspended until the fixes were implemented. Once the LCD updates were implemented, the MACs released and processed the held claims. Any claims inappropriately denied before the LCD updates [...]

Doctor challenges how physicians are evaluated

Physician Credentialing Certification Services at The Firm Services San Diego Union Tribune- By Paul Sisson | 2:37 p.m. Nov. 14, 2015 Dr. Paul Teirstein led a coalition pushing back against unpopular certification rules. In less than two years, Dr. Paul Teirstein of San Diego has led a coalition in convincing the powerful American Board of Internal Medicine to apologize for, and ultimately suspend, unpopular certification rules that would have affected more than 200,000 physicians nationwide. Not content with that success, he and a group of other doctors affiliated with organizations such as Harvard University and the Mayo Clinic have launched their own competing nonprofit to issue board certifications. The San Diego-based National Board of Physicians and Surgeons has issued board certifications to more than 2,700 practitioners. Dr. Ashish Jha, director of the Harvard Global Health Institute and an outspoken advocate for better accountability and transparency in health care, said while the fledgling organization is still tiny compared to its rival, it has the potential to make real change. “The truth is that it remains small and while it’s growing quickly, it is far from posing a real threat to ABIM. That said, I’m glad that they are there, and by offering credible competition to ABIM, the NBPS can make everyone better,” Jha said. “It will force ABIM to more clearly articulate its value to physicians.” Teirstein said only 18 hospitals currently accept the new board’s certifications for the purposes of granting privileges to do surgeries and other treatments, but that the number is rising. In San Diego County, his own hospital affiliate, Scripps Health, is considering acceptance. Teirstein, an interventional cardiologist and chief of cardiology at the Scripps Clinic in La Jolla, has attracted [...]