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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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AnMed Health to pay $7 million to settle False Claims Act allegations

WSPA Channel 7 News Columbia SC- Published: September 27, 2017, 10:58 am Updated: September 27, 2017, 12:37 pm COLUMBIA, SC (WSPA) – AnMed Health has agreed to pay over $7 million to settle allegations that it submitted false Medicare claims. A news release from the U.S. Attorney’s Office states “AnMed Heath knowingly disregarded the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.” Prosecutors allege “AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.” AnMed is also accused of billing a minor care clinic as if it was an emergency department and billed emergency department services as if they were provided by a physician, but were rendered by mid-level providers, according to the news release. Prosecutors say those practices resulted in higher reimbursements to AnMed Health. The allegations came to light following a lawsuit filed by Linda Jainniney. Prosecutors say Jainniney is a whistleblower who used to work for AnMed Health. “This is another example of how the False Claims Act whistleblower provisions help protect the public’s interest,” U.S. Attorney John Horn said in a statement. “It also reflects our ongoing commitment to safeguard our federal health care programs and the vital care that they provide.” “Protecting people with Medicare and guarding health resources are top priorities,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Provider organizations seeking to increase profits at the expense of patients and taxpayers should expect such plans to [...]

By |September 28th, 2017|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Physician Credentialing, Staff Training|Comments Off on AnMed Health to pay $7 million to settle False Claims Act allegations

If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

NPR- September 22, 20173:19 PM ET -Danielle Kurtzleben John McCain on Friday imperiled Republicans' latest Affordable Care Act repeal and replace effort when he said he "cannot in good conscience" support the so-called Graham-Cassidy bill. But McCain did also say he could at some point support the substance of his fellow Republicans' proposal. "I would consider supporting legislation similar to that offered by my friends Sens. [Lindsey] Graham and [Bill] Cassidy were it the product of extensive hearings, debate and amendment," McCain said. "But that has not been the case." That's notable because for the first time since Trump became president, there actually seemed to be some real ideological unity around a repeal-and-replace effort from Republicans. Graham-Cassidy Health Bill Would Shift Funds From States That Expanded Medicaid If it is revived — and this effort isn't quite dead yet, because other GOP holdouts haven't stated their unequivocal opposition publicly — the Graham-Cassidy bill very well may be the foundation of how the health care system is reshaped. What would it mean for where you live? We take a look A big selling point of Graham-Cassidy, according to its proponents, is flexibility for states. In place of the federal dollars that fund Obamacare's subsidies and Medicaid expansion, Graham-Cassidy, which under the latest GOP proposal would be law in 2020, would give states block grants. Those are big chunks of money given directly to states, which would have broad discretion in how to spend them. But what's important is that those block grants would be less money than the total money that states are getting for Obamacare right now. Graham-Cassidy would eliminate the premiums that help people pay for their health insurance and the payments helping insurance companies [...]

By |September 23rd, 2017|Blog, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Optometrist, Physician Credentialing|Comments Off on If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

Medicare for All or State Control: Health Care Plans Go to Extremes

NY Times - By ROBERT PEAR- SEPT. 13, 2017 WASHINGTON — In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans. In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it. Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions. The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon. Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in 2020. “Instead of wasting hundreds of billions of dollars trying to administer an enormously complicated system of hundreds of separate insurance plans, there would be one insurance plan for the American people with one single payer,” said Mr. Sanders, the ringmaster of an event that felt like a political rally, with banners and placards, consumers and patients, [...]

Will Congress Continue Health Care For 9 Million Children?

NPR- September 6, 20175:38 PM ET- PHIL GALEWITZ A popular federal-state program that provides health coverage to millions of children in lower- and middle-class families is up for renewal Sept. 30. But with a deeply divided Congress, some health advocates fear that the Children's Health Insurance Program could be in jeopardy or that conservative lawmakers will seek changes to limit the program's reach. Other financial priorities this month include extending the nation's debt ceiling, finding money for the Hurricane Harvey cleanup and keeping the government open. "With all that is on Congress' plate, I am very worried that a strong, wildly successful program with strong public support will get lost in the shuffle and force states to begin the process of winding down CHIP," said Bruce Lesley, president of the advocacy group First Focus. The program covers more than 9 million kids — typically from families not poor enough to qualify for Medicaid, the state-federal program that covers health care for people with low incomes. Income eligibility levels for CHIP vary widely among states, though most set thresholds at or below 200 percent of the poverty level — about $49,000 for a family of four. Unlike Medicaid, CHIP is usually not free to participants. Enrolled families pay an average premium of about $127 a year. Since CHIP's enactment, the share of uninsured children in the U.S. fell from 13.9 percent in 1997 to 4.5 percent in 2015, according to the Medicaid and CHIP Payment and Access Commission. The 20-year-old program has bipartisan support. One of its original sponsors is Sen. Orrin Hatch, R-Utah, chairman of the Finance Committee, which has scheduled a hearing on reauthorization Thursday. It's possible in the jam-packed legislative calendar this month that other [...]