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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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Wall Street Sees a CVS, Aetna Deal as a Revolutionary Defense

Bloomberg - By Cristin Flanagan October 27, 2017, 7:56 AM PDT Speculation that CVS Health Corp may be making a play to buy Aetna Inc yesterday followed hot on the heels of report that Amazon Inc. had received pharmacy-wholesaler licenses in a dozen states. While a pharmacy acquiring a health insurer may be an unusual step, analysts see it as potentially bold move to fend of the looming Amazon threat and enter an “evolutionary and revolutionary” new world in health care. Others, however, saw an expensive deal and question whether Aetna would be a willing seller. CVS and Aetna shares both fell on Friday morning, down as much as 4.7 percent and 2.9 percent respectively. “We see this potential deal as both evolutionary and revolutionary given the dynamic healthcare environment and push toward consumerism coupled with a challenged retail backdrop and the need to combat a looming Amazon threat. In our opinion, the merits of the deal and potential new model is conceptually compelling, with the biggest questions admittedly, execution, integration, and the structure of the deal. Based on our analysis, we estimate the deal could be 24 cents per share, or 3.7 percent accretive to CVS in year one with greater upside over time if the combined entity successfully manages down healthcare cost. “Could they even do the deal? It’s possible. The reported deal could imply a takeout value of 12.4x trailing 12 months (TTM) Ebitda by our estimate. Based on CVS’ acquisitions of Caremark (in 2006 for 11.8x TTM Ebitda), and Omnicare (in 2015 for 22.0x TTM Ebitda), this deal could be in bounds.” “We think a CVS / AET combination makes a lot of sense. We would imagine a scenario that CVS expands its [...]

I.R.S. Says It Will Reject Tax Returns that Lack Health Insurance Disclosure

NY Times- Health - By REED ABELSON-OCT. 20, 2017 Despite President Trump’s pronouncements, not only is Obamacare not dead, there are signs that his administration is keeping it alive. In the latest signal that the Affordable Care Act is still law, the Internal Revenue Service said this week that it is taking steps to enforce the most controversial provision: the tax penalty people face if they refuse to obtain health insurance. Next year, for the first time, the I.R.S. will reject your tax return when filed electronically if you do not complete the information required about whether you have coverage, including whether you are exempt from the so-called individual mandate or will pay the penalty. If you file your tax return on paper, the agency said it could suspend processing of the return and delay any refund you might be owed. The agency’s new guidance for tax professionals seems to contradict Mr. Trump’s first executive order, on Inauguration Day, which broadly instructed various agencies to scale back the regulatory reach of the federal health care law. As part of his promise to overturn the law, the executive order hinted that the new administration could stop enforcing the mandate that people have insurance or pay a tax penalty, which proponents have long argued is critical to the law’s success by requiring young and healthy people to enroll. The I.R.S.’s guidance makes it clear that taxpayers cannot simply ignore the Affordable Care Act. While the penalty applies only to people without insurance, all taxpayers are required to say whether they have coverage. Legal experts say the I.R.S. has been clear that the law was in effect, despite repeated efforts by Mr. Trump and Republican lawmakers to repeal it. [...]

By |October 22nd, 2017|Blog, doctor, doctor Credentialing, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on I.R.S. Says It Will Reject Tax Returns that Lack Health Insurance Disclosure

Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

The New York Times- By ROBERT PEAR, MAGGIE HABERMAN and REED ABELSON -OCT. 12, 2017 WASHINGTON — President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers. The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own. Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade. “The government cannot lawfully make the cost-sharing reduction payments,” the White House said in a statement. It concluded that “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.” In a joint statement, the top Democrats in Congress, Senator Chuck Schumer of New York and Representative Nancy Pelosi of California, said Mr. Trump had “apparently decided to punish the American people for his inability to improve our health care system.” “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said. “Make no [...]

By |October 13th, 2017|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Obamacare, Physician Credentialing|Comments Off on Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

CMS Reveals New Medicare Card Design

CMS.GOV-  SEPTEMBER 14, 2017  Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In addition to today’s announcement, people with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September. “The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.” CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive. Healthcare providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, healthcare providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition. This initiative takes important steps towards protecting the identities of [...]