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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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Credentialing is a big pain for doctors! Let The Firm Services professionals do it for you.

By Gus Geraci, MD Gus Geraci, MD, is consulting chief medical officer for the Pennsylvania Medical Society. We all know how hard it is to recruit a physician these days. No matter the specialty, finding a compatible physician with the right skills is a major challenge. There’s more on this particular subject coming soon from me in the February 2016 issue of the Pennsylvania Physician magazine, but let’s just assume you’ve overcome all those challenges and actually managed to sign a contract. Let’s put the physician to work! Right? Sure, you can see patients, but there’s a major problem: Getting paid for that. Oh, you did want to get paid, right? So what do you need to do? Insurers have to credential you – that’s each and every insurer for each patient you see. As a family doc, my practice had contracts with something like 50 or more different insurers. Realistically, there are probably only two or three that dominate the market where you work, and they’re the important ones. But each and every insurer has to go through this process. It’s very similar. They have to confirm your identity, your credentials and skills. You’ve hired the physician, and they submitted their credentials (which by the way, is a tremendously laborious and repetitive process), and now it sits in the insurer’s hands. Your start date comes and goes, and you either can’t see that insurer’s patients, or you are welcome to see them but you won’t get paid by the insurer, because until you are credentialed you are not in their network. Depending on their rules, the patient may get stuck paying more (because you’re out of network), or you may have seen that patient [...]

By |April 29th, 2016|Blog, Commercial Insurance, Consulting, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, Physician Credentialing, Uncategorized|Comments Off on Credentialing is a big pain for doctors! Let The Firm Services professionals do it for you.

ICD-10 denials require attention

ICD-10 are you in Denial ? CARL NATALE APR 13, 2016 - 05:46 AM The U.S. healthcare system is not paralyzed by denial despite the ICD-10 implementation. Either the ICD-10 codes are not as burdensome as critics warned or relaxed specificity requirements are letting a lot of unspecified claims through. Even if ICD-10 denials aren't a tsunami of revenue disruption, they still are a challenge that should be monitored and mitigated. It's a challenge getting a handle on it. Allison Gilmore, principal data scientist for healthcare with Menlo Park, California-based Ayasdi, told Healthcare IT News that ICD-10 coding complicates the effort to analyze denial data in two ways: There are only six months worth of data to examine. Small sample size makes it harder to recognize trends. Because there are so many ICD-10 codes, the diagnoses are spread out. This sparsity creates lots of small sample sizes. But the data needs to be collected. For the Record magazine talks to Crystal Ewing, a senior business analyst and manager of regulatory strategy at ZirMed, and gets a couple tips for what to record in addition to diagnoses when it comes to denials: Specific reasons for denials Categories such as: payer procedure code diagnosis code coder patient access staff member scheduler case manager physician referring provider The article also makes the point that denial mitigation isn't all about the numbers and technology. People are at the heart of denial management. And it's not just medical coders who are expected to get the ICD-10 codes correct. Physicians need to understand how important it is to document medical necessity — which will be a major part of preventing denials. Are you in Denials ? Questions about ICD-10 codes and reimbursement? Physician Credentialing and Revalidation [...]

ICD-10 implementation hasn’t ruined healthcare yet

The Firm Services your best resource for ICD-10 issues. Carl Natale APR 8, 2016 - 05:58 AM There is a strong feeling that the ICD-10 transition has gone better than predicted. Not a lot of healthcare providers have come out and given us their disaster stories. Gabriel Perna did a decent roundup of ICD-10's first six months and cited a Physicians Practice survey that claimed 47.3 percent of readers weren't having any ICD-10 problems. I inserted the word claim because I'm doubtful the entire readership responded to the survey which makes the 47.3 percent stat doubtful. It's a semantic point I know. It is interesting that the survey also says the lack of problems includes a claim rejection rate as usual. That point is strengthened by citing a Navicure survey that claimed 60 percent of medical practices weren't seeing a revenue impact. Which is not what the American Medical Association was predicting. Perna backed that up by talking to a medical consultant and clearinghouse exec who say denial rates and revenue have been steady for their clients. As a separate testimonial, Deborah Winiger, who practices family medicine in Illinois, wrote, "As of now we have had no coding issues with insurance companies questioning or denying claims due to coding. " She credits credits her electronic health record (EHR) and a short list of ICD-10 diagnoses needed day-to-day for making ICD-10 coding manageable. Preparation also was a factor cited in Perna's story. Robert Tennant, director of health IT policy with the Medical Group Management Association (MGMA), told Perna that all those delays gave healthcare providers a chance to get ready. But Winiger has some awareness that healthcare payers may be giving her practice the [...]