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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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CMS lifts sanctions on Cigna’s Medicare plans

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services FierceHealthcare- by Leslie Small | Jun 16, 2017 4:48pm Nearly a year and a half after it was hit with government sanctions, Cigna has gotten the green light to resume selling Medicare products. Cigna can start marketing Medicare Advantage and Part D plans immediately and can begin enrolling individuals in those plans with effective dates beginning July 1, the insurer said in a Securities and Exchange Commission filing Friday. Cigna has been banned from both marketing and enrolling people in MA and Part D plans since January 2016. The Centers for Medicare & Medicaid Services said the insurer violated regulations regarding coverage determinations, appeals and grievances; Part D formulary and benefit administration; access to facilities and records; and compliance program effectiveness. These violations led to increased out-of-pocket expenses for enrollees, as well as delays or denials in receiving medical services and prescription drugs, CMS said at the time, noting such issues posed a serious threat to enrollees' health and safety. "We are a better and stronger company as a result of collaborating with CMS and investing further in our processes and technology over the past year and half,” Shawn Morris, interim president for Cigna-HealthSpring, said in a statement emailed to FierceHealthcare. “As a company that puts customers first, we look forward to continuing that partnership while delivering high-quality healthcare plans to both existing and new customers.” The process of fixing the issues cited by regulators has been a lengthy one for Cigna, and it wasn’t able to finish in time to participate in the 2017 open enrollment period for Medicare. Because of that, the insurer said in February that it expects [...]

Expensive medical insurance claims are rising

Credentialing, Revalidation, Medical Billing Services professionals at The Firm Services by Insurance Business 06 Jun 2017 Healthcare claims that breach the million-dollar mark continue to rise, according to Sun Life’s latest catastrophic claims report covering data from 2013-2016. Among other things, the insurance giant found that the number of multi-million-dollar claimants increased 68% from 114 to 192 during that four-year period. While multi-million-dollar cases make up a “small number” of overall claimants, the firm said they are a “greater proportion” of reimbursement dollars. In 2016, multi-million-dollar cases made up 2.2% of claimants but generated 23% of total stop-loss reimbursements. Over the four-year period, total costs for catastrophic claims reached $6.1 billion, with $2.7 billion paid in stop-loss reimbursements. The firm found that cancer dominates the top 10. Based on dollar amount and percentage of total stop-loss claims, “malignant neoplasms” and “leukemia/lymphoma/multiple myeloma (cancers)” took spots one and two on the list, representing more than a quarter (26.7%) of total stop-loss reimbursements from 2013-2016. Of the top-10 conditions, the highest claim was $3.2 million, for malignant neoplasm (cancer). For breast cancer – the most common form of cancer in the US – an average paid claim amounted to $147,100. IV medications tracked in the study pushed up costs – When looking at data on intravenous drugs, the report showed they accounted for 48% of total paid charges on the top five highest-dollar claimants. Of the 562 claimants exceeding $1 million between 2013 and 2016, 45 generated more than $1 million in high-cost intravenous medications. “Health insurance is for the unexpected. Providing full coverage for catastrophic medical events without lifetime limits as designed under the Affordable Care Act is the right thing to do,” said [...]

Dirty, Dingy Hospitals: Doctors Blame Debt-Fueled Takeovers

Bloomberg- by John Lauerman and David Welch- June 1, 2017, 8:17 AM PDT There are two groups Community Health Systems Inc. can’t push too far: the doctors at its hospitals, and the debtholders it owes billions of dollars. Right now, the creditors are winning, and the doctors aren’t happy. In Fort Wayne, Indiana, the rancor about Community’s neglect of a local health system has gotten so bad that a group of doctors tried to get rid of corporate ownership and buy the company out. And 1,500 miles away on the island of Key West, Florida, doctors say patients are being overcharged so that Community, sometimes called CHS, can rake in cash. The two locations are among Community’s most lucrative, and their conflicts are part of the flip side of an industrywide acquisition binge over the last decade. For-profit hospital chains like Community borrowed billions to snap up rivals, facing massive debt reimbursements just as the benefits of the Affordable Care Act, known as Obamacare, began to wane. “I understand that they have billions in debt and may need to take money from this chain to service it,” said William Pond, an anesthesiologist at one of the Fort Wayne hospitals and president of the county health department’s executive board. “But it’s very disappointing to see the course that CHS is taking and the devastating effect they’re having on our community.” Once the biggest U.S. for-profit hospital chain, Community is selling off other, poorly performing facilities to pay off $2 billion of its $15 billion in debt. Yet even as the company skimps on spending and patient satisfaction lags at key facilities like Fort Wayne, its bonds are rising in value -- an indication that debtholders are betting [...]