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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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Poll: Most older Americans want Medicare to cover long-term care

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services CBS News- AP / May 26, 2017, 7:44 AM WASHINGTON -- A growing number of Americans age 40 and older think Medicare should cover the costs of long-term care for older adults, according to a poll conducted by the Associated Press-NORC Center for Public Affairs Research. That option is unlikely to gain much traction as President Donald Trump's administration and Republicans in Congress look to cut the federal budget and repeal President Barack Obama's 2010 health care law. Most older Americans mistakenly believe they can rely on Medicare already for such care, the poll shows, while few have done much planning for their own long-term care. Things to know from the AP-NORC poll of older adults: MOST WANT MEDICARE TO PAY More than half of older Americans - 56 percent - think the federal government should devote a great deal or a lot of effort to helping people with the costs of long-term care, and another 30 percent think it should make a moderate effort to do so. According to the poll, 56 percent of Americans age 40 and over think Medicare should have a major role in paying for ongoing living assistance, up from 39 percent who said so in 2013. Majorities of both Democrats and Republicans now think Medicare should bear a large part of the burden. The poll has other signs of growing support for government involvement in providing long-term care. Seventy percent of older Americans say they favor a government-administered long-term care insurance program, up from 53 percent who said so a year ago. Most also favor tax policies to encourage long-term care planning, including tax breaks [...]

DOJ pursues UnitedHealth in second Medicare fraud suit

Axios- Bob Herman-  May 17 The Department of Justice is intervening in a second whistleblower lawsuit that alleges UnitedHealth Group, the largest health insurance and services company in the country, has defrauded the Medicare Advantage insurance program by exaggerating people's medical diagnoses to obtain more federal dollars. Why this matters: These lawsuits have some explosive allegations and threaten a company that dominates a growing and lucrative Medicare industry. In addition, the Center for Public Integrity and a federal watchdog agency have reported numerous instances of insurers manipulating a Medicare patient's "risk score" to get more money. The bottom line: This will be one of the most closely watched federal court cases in health care considering billions of taxpayer dollars are on the line. UnitedHealth is fighting back: "The complaint shows the Department of Justice fundamentally misunderstands or is deliberately ignoring how the Medicare Advantage program works. We reject these claims and will contest them vigorously," spokesman Matt Burns said. The company also said it has pursued administrative action to resolve what it views are unclear policies. Context: Nearly 20 million seniors and disabled people are enrolled in a Medicare Advantage plan, and UnitedHealth covers almost a quarter of them, or about 4.7 million. The back story: The latest whistleblower allegations come from the company's former director of finance who oversaw the Medicare Advantage business — someone with deep knowledge of the "risk adjustment" coding practices in question. Here are some eye-catching claims from the lawsuit: UnitedHealth looked at medical charts to add patient diagnoses where possible, but it did not always delete invalid diagnoses. Top executives, all the way up to UnitedHealth CEO Stephen Hemsley, were aware of an internal program that verified medical claims and [...]

House Passes Measure to Repeal and Replace the Affordable Care Act

NY Times- By THOMAS KAPLAN and ROBERT PEAR MAY 4, 2017 WASHINGTON — The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage. The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement. The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch. “To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.” Even before the vote, some Republican senators had expressed deep reservations about one of the most important provisions of the House bill, which would roll back the expansion of Medicaid under the Affordable Care Act. With $8 Billion Deal on Health Bill, House G.O.P. Leader Says ‘We Have Enough Votes’ MAY 3, 2017 But a softening of the House bill, which could help it get through the Senate, would present new problems. For any repeal measure to become law, the House and the Senate would have to agree on the language, a formidable challenge. The House voted on Thursday on a revised health care bill that would [...]