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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.


Anthem links Obamacare expansion with approval of Cigna acquisition

Politico- By PAUL DEMKO 07/28/16 02:15 PM EDT Anthem on Wednesday fought back against an Obama administration antitrust lawsuit by conditioning its expansion in the struggling Obamacare market to approval of its acquisition of Cigna. The company plans to add nine states to its Obamacare participation if the deal goes through, company officials said on a call with investors. The DOJ last week sued to block Anthem's proposed $54 billion acquisition of Cigna, citing concerns about harm to competition, and also filed suit against Aetna's planned $37 billion takeover of Humana. If successful the mergers would reduce the number of major national carriers from five to three. Anthem CEO Joe Swedish indicated that the company remains committed to the Obamacare exchanges despite the "many and continuing challenges" of the fledgling marketplaces. The company had 923,000 exchange customers in 14 states at the end of the second quarter of this year. "Our acquisition of Cigna will help stabilize pricing in this volatile market, enabling Anthem to continue its commitment to the public exchanges," Swedish said. Two other major national carriers have announced significant pullbacks from the exchange markets because of losses. UnitedHealth Group is pulling out of most of the 34 states where it currently competes. Humana is leaving eight of the 19 states where it sells products in the individual market. A trial on the Cigna deal should start in federal court in Washington, D.C., in October and take roughly four months, Anthem officials said. "Obviously we’re going to run out the litigation as long as it takes," Swedish said. Questions about commercial insurance reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services [...]

ObamaCare and Big Insurance

The Justice Department tries to block the mergers that Obama’s health law intended. Wall Street Journal- July 24, 2016 6:15 p.m. ET Politicians tend to be most enraged by the problems they cause, and the liberal fury against insurance mergers is a classic of the genre. ObamaCare was designed to create government-directed oligopolies, but now its authors claim to be alarmed by less competition. Last week federal and 11 state antitrust regulators filed a double lawsuit to block the pending $54 billion insurance tie-up between Anthem and Cigna and the $37 billion acquisition of Humana by Aetna. The mergers would reduce the national commercial insurers to three from five, and Attorney General Loretta Lynch says the government won’t cede such “tremendous power” over health care to a more concentrated industry. Has she checked with the White House? The logic of ObamaCare is that larger and more integrated conglomerates are superior to a market with many insurers, doctors and hospitals vying for consumer business. The law promotes corporatism on the theory that larger systems are more efficient, but also because giants are easier to control politically and will standardize care as ordered. The new regulations and mandates since the law passed in 2010 are designed to encourage consolidation, from accountable care organizations to new reimbursement methods and much else. The rise of huge health systems, salaried physicians and mega-insurers is precisely what Peter Orszag and Jonathan Gruber wanted. But now the trust busters are fretting that these giants will have less incentive to innovate to reduce costs and improve quality, and patients will have fewer choices. Well, yes—as critics predicted. “Competitive insurance markets are essential to providing Americans the affordable and high-quality health-care they deserve,” Ms. [...]

Calling Cadillac Tax A Lemon, Congress Moves To Repeal Core Of Obamacare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services JUL 15, 2016 @ 09:08 AM - Forbes -Robert Wood More than 300 members of the House support legislation to repeal the Cadillac tax. The Cadillac tax is a 40% tax on the cost of employer-sponsored health coverage exceeding certain thresholds. Those ‘Cadillac’ thresholds are actually more Yugo territory: $10,800 for self-only coverage, and $29,100 for family coverage. What’s more, the cost of wellness programs, on-site clinics and other plan features meant to reduce expenses are also included. The result is that vast number of participants in numerous employer-sponsored plans will be affected. There are two bills in the House, H.R. 879 introduced by Rep. Frank Guinta (R-NH), and H.R. 2050, introduced by Rep. Joe Courtney (D-CT). The House and Senate may actually do it this time. Those favoring repeal come from all corners. But a major advocate for repeal is the Alliance to Fight the 40, a coalition of public and private employers, patient advocates, businesses, unions, and more. And they are racking up the votes and sponsors. The Supreme Court upheld Obamacare as a tax law, and it contains many taxes, including the Cadillac tax. It is a whopping 40% on top of all other federal taxes. It had a clever delayed effective date that was supposed to make it easier for all of us to swallow. Obamacare was passed in 2010, but the Cadillac tax was deferred until 2018. Later, Congress rolled it back two more years, to 2020. That delayed effective date clearly de-emphasized the importance of the provision. But when it does hit, it will hit with a vengeance. It was supposed to target overly generous employer-provided health care plans. That doesn’t just mean for executives. In fact, the tax mostly appears to hit union [...]

Illinois suspends insurer’s Obamacare payments until feds pay up

Let the Experts at The Firm Services assist your practice. By Lauren Clason - 07/07/16 07:49 PM EDT A cash-strapped Illinois health insurer won’t be sending Obamacare payments to Washington until the feds pay their bill first, according to the state’s top insurance official. The acting director of the Illinois Insurance Department is preventing Land of Lincoln Health, the state’s troubled Consumer Operated and Oriented Plan (CO-OP) from paying money owed under the Affordable Care Act unless Washington hands over funds the insurer says are due under a separate but similar provision of the law. Anne Melissa Dowling said in a June 30 letter to ACA Marketplace CEO Kevin Counihan she is suspending payments of nearly $32 million that Land of Lincoln Health owes the Centers for Medicare and Medicaid Services under the risk-adjustment program, one of the law’s premium stabilization programs designed to soften the blow of heavier regulations. Land of Lincoln Health is currently suing the federal government for $73 million it claims it’s owed under a similar program known as risk corridors. Paying the CMS bill would force the state to liquidate Land of Lincoln, Dowling said, which “would trigger marketplace disruption and extreme financial harm” to the CO-OP’s 49,000 members. Dowling signed a June 27 order preventing the CO-OP from making payments until CMS fulfills its risk-corridor program obligations. The Illinois CO-OP in June became the latest insurer to sue the administration after the federal government announced last fall it would pay only 12 percent of the $2.87 billion in risk-corridor payments sought by insurers in 2015. The payments were cut after Congress enacted a bill that rendered the program budget-neutral, preventing the agency from pulling funding from other [...]