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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.


How is ICD-10 affecting claim denials?

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES ICD 10 WATCH CARL NATALE JAN 27, 2016 - 06:00 AM There are some mixed messages on how much claim denials have risen since Oct. 1. Some healthcare providers are reporting a few ICD-10 denials but not enough to worry about. On the other hand, a healthcare consultant found out that a California HMO was denying medical claims on a massive scale. And NCDs and LCDs have needed tweaks to prevent mistaken denials. If this isn't a major national problem, it certainly can be a major problem for individual medical practices. So it needs to be fixed. First, measure ICD-10 claim denials and monitor revenue-based metrics. It is important to understand where the problems are occurring. Then medical practices can start fixing the problems that create denials. Second, figure out if the right ICD-10 codes are being used. There is lots of room for error so make sure the medical claims are coded correctly and clinical documentation supports the diagnoses. Keep investing in coding training. Third, keep calling the healthcare payers until they answer questions. Do not let any denial go because it's too much work. Best advice: Prevent denials Chris Nerney at Revenue Cycle Insights identifies three things that can help healthcare providers prevent claims denials: Registration processes: Denial problems can start before the first ICD-10 code is recorded. Medicaid: Which comprises 13 percent of all denials. Start by checking eligibility, medical necessity and pre-authorization. High-impact specialties: Specialties contribute heavily to major amounts of claim denials. (Repeat the advice in the first two tips). In a way, the macro claim denial statistics don't matter as much as the individual anecdotes. Those stories are [...]

Cigna temporarily banned from new Medicare plans

USA Today Nathan Bomey January 23, 2016 U.S. regulators have temporarily banned health insurer Cigna from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings. The insurer disclosed late Thursday in a public filing that the U.S. Centers for Medicare and Medicaid Services (CMS), had suspended the company from enrolling new customers or marketing plans for Cigna Medicare Advantage and Standalone Prescription Drug Plan Contracts. In an enforcement letter, CMS accused Cigna of "widespread and systemic failures," including the denial of health care coverage and prescription drugs to patients who should have received them. The actions "create a serious threat to enrollee health and safety," said CMS, which is requiring Cigna to appoint an independent monitor to audit its handling of the matter. The sanctions, which took effect at the end of the day Thursday, do not affect patients who are already enrolled. CMS said could not provide an estimate for how many patients were affected. Cigna had market share of 3% in Medicare Advantage plans in 2015, representing about 502,000 patients, according to the Kaiser Family Foundation. “As a company committed to delivering quality products and services, we focus on putting customers first. The findings in the audit are unacceptable and will be addressed in full partnership with CMS,” said Herb Fritch, president of Cigna-HealthSpring, in a statement. “We have internal quality review processes in place that identified some of the areas in advance of the audit findings and we have already started working to remedy them. In other instances, we will implement the changes as quickly as possible to emerge a stronger organization further dedicated to those we serve.” Cigna shares fell 1.2% to $138.52 as of [...]

ICD-10: So Far, So Good

ICD-10 are you in compliance? Five key measurements for monitoring current trends By Mike Denison, senior director, regulatory compliance programs, Change Healthcare Posted on: January 11, 2016 After much planning and anticipation, the October 1, 2015, ICD-10 transition deadline has finally come and gone. Now that the dust is settling, the big question on everyone's mind is: "What impact has it had?" Providers, payers and other stakeholders have spent years working diligently to prepare for the transition to the new code set. While many held their breath in the early weeks of the transition, it appears that the industry can now breathe a collective sigh of relief. Early indicators suggest that the hard work and significant financial investment have paid off as potential issues associated with healthcare transaction processing and payments have been minimal to date. In light of the magnitude of the transition, some providers naturally have experienced a few expected revenue cycle hiccups. These issues should continue to diminish in the coming months, however, as healthcare organizations tweak their systems and identify opportunities for process improvement. The good news is that a review of ICD-9 and ICD-10 claims to date reveals that there is little variance in trends related to average payments and denial rates. Current Trends: A Closer Look Change Healthcare is closely monitoring ICD-10's impact and, thus far, has seen positive trends based on the results of five key measurements, including: 1) Overall ICD-10 use ramp-up compared to forecast; 2) Provider readiness; 3) Clearinghouse and payer rejections; 4) Average payments and denial rates by payer model; and 5) ICD-10 related support caseload. In terms of the forecasted ramp-up rate, the volume of ICD-10 coded claims has trended within 1-2% of [...]

Three ways ICD-10 coding will affect 2016

ICD-10 is here. Are you ready for 2016? by CARL NATALE- DEC 30, 2015 - 06:00 AM This is the time to do a year-in-review post. But the only event worth recapping was the adoption of ICD-10 coding Oct. 1. In the time since, we've constantly noted that there wasn't enough data to know if that was a good thing or not. Regardless, we need to move into 2016 with ICD-10 coding. Here's how it will matter: Big (and small) data will be used We promised that ICD-10 data will lead to a new age in healthcare. Of course that's not going to happen unless healthcare professionals use the data. But data analysis is not easy for everyone to embrace. The value isn't obvious. But if medical practices can associate diagnosis data with revenue, then the business starts looking different. Or if they can see trends in the diagnoses, they could help patients better. Even if you're not believer in data, the federal government and private payers are. They're going to examine your ICD-10 data to find ways to cut their costs. Maybe it's not as simple as cutting reimbursements. But maybe they figure out how to invest money upfront to avoid recurring treatments. Find a way to understand your data instead of accepting what someone else tells you. Electronic health records (EHRs) will need checkups In the first hours of ICD-10 use on Oct. 1, there were complaints about how ICD-10 codes made EHRs too complicated. All of a sudden, there were extra pull down menus. Cheat sheets were complicated. Maybe the problem wasn't the ICD-10 codes. Maybe the problem was the EHRs. IT purchases are hard to get right. Many don't [...]