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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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How the New U.S. Tax Plan Will Affect Health Care

Harvard Business Review: David Blumenthal- December 19, 2017 The new Republican tax bill, which the House passed this afternoon and the Senate is expected to approve tonight, is complex, but what it will mean for health in the United States is simple: less. It will mean less health insurance for individuals; less coverage for elderly and poor Americans; less revenue for doctors, hospitals, and myriad health care businesses; and, quite possibly, a less-healthy, less-productive workforce. The tax bill will be the most important health care legislation enacted since the Affordable Care Act (ACA) in 2010. The law’s two major health-related aspects are the elimination of the penalties paid by people who fail to have health insurance as required by the so-called individual mandate, and the bill’s overall impact on the federal deficit — which will increase by an estimated $1.45 trillion after allowing for predicted economic growth. According to the Congressional Budget Office (CBO), the repeal of the individual mandate penalties could result in as many as 13 million fewer Americans having health insurance. About 5 million are projected to be people who previously bought health insurance as individuals either within or outside the ACA’s marketplaces. Some will choose not to buy insurance because the penalty has disappeared. Others, especially higher-income individuals who don’t qualify for subsidies under the ACA, will drop insurance because of increases in average premiums predicted by the CBO. These premium increases will occur because, with the repeal of the mandate, many young, healthy people will exit markets, leaving a sicker, more costly insurance pool behind. Older individuals will be most affected. For example, a 60-year-old not receiving subsidies could face premium increases of $1,781, $1,469, $1,371, and $1,504, respectively, in Alaska, [...]

UnitedHealth Buys Large Doctors Group as Lines Blur in Health Care

NY Times - By REED ABELSON DEC. 6, 2017 In another example of the blurring boundaries in the health care industry, UnitedHealth Group, one of the nation’s largest insurers, said on Wednesday that it is buying a large physician group to add to its existing roster of 30,000 doctors. UnitedHealth’s Optum unit will acquire the physician group from DaVita, a large for-profit chain of dialysis centers, for about $4.9 billion in cash, subject to regulatory approval. DaVita operates nearly 300 clinics across a half-dozen states, including California and Florida. With the purchase, UnitedHealth is increasingly moving into the direct delivery of medical care. “Combining DaVita Medical Group and Optum advances our shared goal of supporting physicians in delivering exceptional patient care in innovative and efficient ways,” Larry C. Renfro, Optum’s chief executive, said in a statement. Analysts praised the move as keeping with UnitedHealth’s broader goal of building a large ambulatory care business. “The asset is strongly synergistic” with the company’s overall “mission and strategy,” Ana Gupte, an analyst for Leerink, told investors after the deal was announced. The proposed acquisition comes after the announcement that another big insurer, Aetna, planned to merge with CVS Health. That transaction, if approved, could transform CVS’s 10,000 drugstores into community-based health care “hubs,” where people could get blood tests or help managing a chronic disease like diabetes. Executives at Aetna and CVS said that this new model would result in better care and lower costs for patients. At a time of growing uncertainty in the health care marketplace, doctors, drugstores, hospitals and insurers are looking outside their traditional businesses to join forces. The tax overhaul proposed congressional Republicans could cut payments to federal programs like Medicare sharply and upend [...]

By |December 14th, 2017|Blog, Consulting, doctor, doctor Credentialing, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on UnitedHealth Buys Large Doctors Group as Lines Blur in Health Care

UnitedHealth’s Splish Beats CVS-Aetna’s Splash

Bloomberg Gadfly - By Brooke Sutherland Max Nisen - Dec 6, 2017 11:52 AM EST UnitedHealth Group Inc. is that kid in school who's always doing better than you.The $214 billion company announced on Wednesday that it's buying DaVita Inc.'s physician-network business for $4.9 billion. It's just the latest step in UnitedHealth's push to diversify its revenue. Thanks to deals over the past few years, the company isn't just the largest private U.S. health insurer, it's also a pharmacy-benefit manager, a health care analytics company and increasingly a provider of medical care through physician clinics, outpatient services and urgent care centers. *The company's two largest insurer purchases -- of units of Fiserv and Sierra Health Services -- were both announced in 2007 and included a number of non-insurance businesses that likely now fall under Optum This is the blueprint that CVS Health Corp. and Aetna Inc. are attempting to follow with their $77 billion merger. Antitrust authorities have made abundantly clear that they aren't fans of further consolidation among the top health insurers nor among the top drug-store operators, forcing companies to look elsewhere in the health-care world for growth opportunities. UnitedHealth has proven that diversification does more than just create new revenue streams -- it also offers cost, information, and convenience advantages that can in turn bolster the appeal and performance of the insurance unit. The problem for CVS-Aetna is that UnitedHealth had the idea first, and the DaVita deal is a reminder that it has no intention of slowing down. UnitedHealth is a much larger provider of medical services than many people realize, and deals like the DaVita acquisition and its $3.2 billion purchase of outpatient-services provider Surgical Care Affiliates Inc. earlier this year have [...]

On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’

LA TIMES - Micahel Hiltzik- November 27, 2017 Child healthcare advocates have been warning, and warning, and warning that Congress’ delay on reauthorizing funds for the Children’s Health Insurance Program places health coverage for as many as 9 million children and pregnant women at risk. But since the funding expired Sept. 30, there has been no action by Congress. Now, advocates say, “the nightmare scenario is close” for states across the country, to quote former Medicare and Medicaid chief Andrew Slavitt, as the state-federal program runs out of federal money. State officials in Colorado started sending letters to families on CHIP as early as Monday, warning them that their kids’ health insurance could run out Jan. 30 and they should “start researching private health insurance options.” If Congress doesn’t vote within two weeks to resume the program’s $15 billion in annual funding, the state officials said, they would send out official notification of the program’s cancellation. A similar high-wire act is playing out in at least 11 states whose CHIP coffers will be exhausted by the end of December, according to the Kaiser Family Foundation; that roster includes California. In Colorado and 20 others, there’s just enough money left from earlier appropriations to last into the first month or so of 2018. We’ve sounded the alarm about the expiration of CHIP in four columns since May, when congressional dysfunction built to the point that a reauthorization of CHIP by Sept. 30 began to look doubtful. The fears of children’s advocates proved true when the deadline passed without a vote; but even then most assumed that the delay would be brief, and the issue would be resolved before too many states had to take stringent measures. [...]

By |December 1st, 2017|Blog, Commercial Insurance, Credentialing, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Obamacare, Physician Credentialing|Comments Off on On children’s health coverage, congressional inaction has brought us to the ‘nightmare scenario’