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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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Why Obamacare Is Still in Peril

NY Times - By THE EDITORIAL BOARD JULY 28, 2017 In a dramatic last-minute spectacle, the latest Republican plan to destroy the Affordable Care Act was defeated early Friday because of the courageous votes of three senators: Susan Collins, John McCain and Lisa Murkowski. This will come as an immense relief to millions of Americans who stood to lose their health insurance, but it would be naïve to think that this is the end of the road for the repeal-Obamacare movement. For the last seven years, Republican leaders have engaged in a fraudulent campaign against the A.C.A. based on the lie that the law is either unworkable or collapsing. The law, which is based on conservative market-based ideas, is certainly flawed and could be improved, but it has helped 20 million people gain insurance and, as a result, provided needed medical care to the poor and the sick. Not only was the Republican diagnosis wrong, but also leaders like the House speaker, Paul Ryan, and the Senate majority leader, Mitch McConnell, tried to push through legislation that was devoid of any ideas and would have weakened the health care system and left millions unable to afford health care. One telling sign: Insurance companies, hospitals, doctors and public interest groups like AARP opposed pretty much every proposal the Republicans put out over the last seven months. Ultimately, this deceitful campaign ran aground by the narrowest of margins in the Senate thanks to the three Republicans and all 48 Democrats and independents. Much attention has rightly focused on Mr. McCain. Returning to the Senate after surgery and a brain cancer diagnosis, he delivered a stirring speech on Tuesday calling on lawmakers from both parties to reach “agreements made [...]

Even Talking About Weakening Obamacare Provisions Weakens The Exchanges

NPR- July 21, 201710:56 AM ET DANIELLE KURTZLEBEN The Affordable Care Act is not "exploding" or "imploding," as President Trump likes to claim. But Trump does hold several keys to sabotaging the insurance marketplaces, should he so choose — one of which his administration is reportedly weighing using. Every month, the Trump administration faces a deadline to pay what are called "cost-sharing reduction" (or CSR) subsidies to insurers. Those are subsidies that reimburse insurers to help low-income marketplace customers afford health care, on top of the tax credits that help those people pay their premiums. A lawsuit filed by House Republicans during the Obama era has left the fate of those payments uncertain. Trump reportedly wants to end the payments, as Politico reported, but the White House chose this week to continue the payments once again. Still, the ongoing ambiguity about the future of the payments is apparently causing premiums to rise and insurers to pull out of markets. Obamacare isn't "imploding," but insurers are shaken Recent analyses from multiple organizations (including the Department of Health and Human Services itself) show that the exchanges aren't imploding; in fact, they're relatively stable. But the Affordable Care Act, also known as Obamacare, does have its problems: Premiums continue to increase, as they did throughout Obama's presidency (though subsidies have shielded a majority of people on the exchanges from those increases), and insurers have backed out of exchanges. Ending the CSR payments could be catastrophic for the exchanges. It could cause premiums to rise by 19 percent or even more, as the Kaiser Family Foundation found in a recent analysis — and that assumes that insurers even stay in the exchanges, Kaiser added. Uncertainty Over Obamacare Leaves Next Year's Rates [...]

Major insurance groups call part of health bill ‘unworkable’

By ALAN FRAM, ASSOCIATED PRESS WASHINGTON — Jul 15, 2017, 11:21 AM ET Two of the insurance industry's most powerful organizations say a crucial provision in the Senate Republican health care bill allowing the sale of bare-bones policies is "unworkable in any form," delivering a blow to party leaders' efforts to win support for their legislation. The language was crafted by conservative Sen. Ted Cruz, R-Texas, and leaders have included it in the overall bill in hopes of winning votes from other congressional conservatives. But moderates have worried it will cause people with serious illnesses to lose coverage, and some conservatives say it doesn't go far enough. Two of the 52 GOP senators have already said they will oppose the legislation. Senate Majority Leader Mitch McConnell cannot lose any others for the legislation to survive a showdown vote expected next week. The overall measure represents the Senate GOP's attempt to deliver on the party's promise to repeal President Barack Obama's health care law, which they've been pledging to do since its 2010 enactment. The criticism of Cruz's provision was lodged in a rare joint statement by America's Health Care Plans and the BlueCross BlueShield Association. The two groups released it late Friday in the form of a letter to McConnell, R-Ky. "It is simply unworkable in any form," the letter said. They said it would "undermine protections for those with pre-existing medical conditions," increase premiums and lead many to lose coverage. The provision would let insurers sell low-cost policies with skimpy coverage, as long as they also sell policies that meet a stringent list of services they're required to provide under Obama's law, like mental health counseling and prescription drugs. Cruz says the proposal would [...]

Obamacare and Trumpcare Both Ignore This Massive Underlying Healthcare Issue

Lawmakers are so focused on ensuring people have access to health insurance that they've completely overlooked the root causes of medical care inflation. Sean Williams (TMFUltraLong)  Jul 8, 2017 at 6:49AM Who knew healthcare could be so complicated? Apparently not the president or Congress, as both are struggling to reach a consensus as to what to do with the future of healthcare in America. Obamacare: Should it stay or should it go? Obamacare, which is officially known as the Affordable Care Act (ACA) and was signed into law by Barack Obama in March 2010, has been controversial and mostly disliked since the start. However, it's been successful in reducing the number of people without insurance. The expansion of Medicaid in 31 states, the provision of subsidies for low- and middle-income Americans, and insurance mandates that require member acceptance, regardless of pre-existing conditions, have been crucial in pushing the uninsured rate down to around 9% from 16%, according to data from the Centers for Disease Control and Prevention. At the same time, Obamacare has had its shortcomings. The Shared Responsibility Payment (SRP), which is the penalty consumers pay for not purchasing health insurance, has been far too low relative to the cost of buying an annual health plan, thus fewer young, healthy people have enrolled than expected. The risk corridor, which was a fund designed to provide money to insurers with excessive losses that had set their premiums too low, also sputtered due to insufficient funding. With little in the way of financial protections for insurers, many big names have significantly reduced their ACA plan coverage in 2017 and beyond. There are ways Obamacare can be fixed. These include adjusting the penalty on the SRP upward [...]

Five myths about health insurance…

Washington Post- By Alexis Pozen June 30, 2017 Alexis Pozen is a professor of Health Economics at CUNY School of Public Health and a co-author of the textbook "Navigating Health Insurance. It is no wonder so many myths about health insurance persist. The U.S. health insurance system is opaque and labyrinthine, and at times purposely so. The current debate over whether to repeal major provisions of the Affordable Care Act (ACA), otherwise known as Obamacare, comes down to whether consumers should subsidize services they never expect to use. But who pays for what, and how, is not straightforward. MYTH NO. 1 The ACA has forced millions to buy insurance they don’t want. House Speaker Paul Ryan deployed this myth when defending repeal — which the Congressional Budget Office estimated this past week would increase the number of uninsured people by 22 million by 2026. “It’s not that people are getting pushed off a plan,” Ryan said. “It’s that people will choose not to buy something they don’t like or want.” That reasoning echoes the late Supreme Court justice Antonin Scalia, who during a 2012 challenge to the ACA suggested that the law’s individual mandate started the federal government down a slippery slope. “Everybody has to buy food sooner or later,” he said. “Therefore, you can make people buy broccoli.” And no one wants broccoli, right? But both before and after the ACA, most of the uninsured consistently have reported that they want insurance. In a 2009 Department of Health and Human Services report, 48 percent of uninsured people under age 65 said they didn’t have health insurance because of the cost, 38 percent cited life changes (they had lost their jobs, left school or changed their [...]