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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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When your insurer denies a valid claim because of ‘lack of medical necessity’

Los Angeles Times- By DAVID LAZARUS -JAN 23, 2018 | 3:00 AM We learned last week that roughly 3.2 million more Americans were uninsured in 2017 — hard data attesting to how Republicans' cold-hearted obsession with overturning Obamacare is playing out in the real world. According to the Gallup-Sharecare Well-Being Index, the U.S. uninsured rate rose to 12.2% last year after plunging to a low of 10.9% by the end of 2016. Prior to Obamacare, the uninsured rate nationwide was as high as 18%. Yet the number of people covered is only half the healthcare story. The other is quality of coverage for those fortunate enough to have health insurance. Frequently, it can be a struggle for patients to receive coverage for legitimate claims. Denial letters from profit-minded insurers are an all-too-common aspect of our healthcare system, requiring patients and their families to jump through deliberately tedious bureaucratic hoops at a time when their attention is elsewhere. Count me among that number. I received a letter the other day from my employer's insurer, Blue Cross Blue Shield of Illinois, denying my claim for a new insulin pump. The reason: "Lack of medical necessity." This is intriguing on a number of levels: I have Type 1 diabetes, an incurable autoimmune disease requiring multiple daily insulin injections. It won’t just go away. I have used an insulin pump for the last nine years. I’ve never submitted a claim for a costly diabetes-related complication, such as neuropathy or retinopathy, so clearly I’m doing something right. If you’re an insurance company, you absolutely want to do whatever you can to save a buck by helping me manage this illness. I'm not sharing this out of self-interest. I fixed things prior [...]

By |January 25th, 2018|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 When your insurer denies a valid claim because of ‘lack of medical necessity’

This Company’s AI-Fueled Tech Is About to Bring Digital Health Care to Millions

FORTUNE- By SY MUKHERJEE 7:00 AM EST - JANUARY 17,2018 Digital health firm HealthTap and Bupa, a health care provider that offers both insurance and medical services to millions around the world, are teaming up in a massive strategic partnership that could make “digital end-to-end” medical services a widespread reality, HealthTap CEO Ron Gutman told Fortune in an early interview previewing the arrangement. Gutman describes it as the “biggest digital health deal” he knows of. That’s a bold claim; but the company’s new partnership with Bupa can’t be easily brushed off. Bupa does both the grunt work of medical care services (through hospitals and clinics) and the more heady business of insurance; it employs about 80,000 people around the world and has a far larger consumer base that stretches across the globe. By combining forces with Bupa, HealthTap’s artificial intelligence-powered services—which can allow patients to figure out whether they need to immediately go to a hospital if they’re feeling sick, access doctors through virtual visits, receive reminders about taking or refilling prescription medications, and generally keep one, unified record of their medical history—will be available to millions, according to the companies. Those are all goals (and technologies) that plenty of other digital health upstarts are seeking. So what makes HealthTap’s latest collaboration different? “Everything in one app,” says Gutman. He describes it as a true “end-to-end” digital service for medicine, where even the insurance part of the equation is taken care of within the app. “Over the past year we have worked together to implement a number of solutions for day-to-day customer needs, such as easily finding local doctors covered by Bupa insurance, scheduling physiotherapy, immunizations, and doctor visits with local clinics, and connecting residents in [...]

By |January 17th, 2018|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on This Company’s AI-Fueled Tech Is About to Bring Digital Health Care to Millions

CVS-Aetna deserves chance to disrupt health-care system

THE HILL : BY DR. ROGER KLEIN, OPINION CONTRIBUTOR — 01/10/18 07:00 PM EST -THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL On Dec. 3, drugstore chain CVS announced that it would purchase insurer Aetna for $69 billion, making this the largest health insurance merger in American history. The acquisition comes on the heels of a period of consolidation in the health-care industry that has been driven by rapidly increasing costs, declining reimbursement, technological change, increasing regulatory burdens and legislative changes, most prominently the Affordable Care Act. Its purpose is to allow these two entities to more effectively compete with other integrated providers like UnitedHealth Group, with its physician practices, surgery centers, urgent care clinics and pharmacy benefit manager, Kaiser Permanente, Geisinger Health System, more conventional providers like hospitals and physician groups and even disruptive retailers like Amazon. The CVS-Aetna merger is known as a “non-horizontal” merger. This means that the merging companies are neither actual nor potential competitors in the same markets. Instead, the CVS-Aetna combination brings together sellers whose relevant products are mostly complementary goods and services like prescription drugs, pharmacy benefit management, primary care and health insurance. The merger also has “vertical” elements. For example, health insurers are often purchasers of prescription drugs, pharmacy benefit management services, prescription drugs and other pharmacy products. Historically, federal enforcement activity has centered on “horizontal” mergers, that is, mergers of competitors. Typically, horizontal mergers present a greater risk of harming consumers than do non-horizontal mergers. However, the recent Justice Department lawsuit challenging AT&T’s $85 billion purchase of Time Warner and remarks Assistant Attorney General for the Antitrust Division Makan Delrahim made at an American Bar Association conference in November [...]

Tax on medical devices to resume after 2-year suspension

CNBC via AP- JANUARY 1ST, 2018 While much of corporate America will enjoy a tax cut in the new year, one industry is getting a tax increase it has fought hard but so far unsuccessfully to avoid. A 2.3-percent excise tax on medical device manufacturers is set for reinstatement Monday after a two-year hiatus. It was originally imposed in 2013 as one of several taxes and fees in the Affordable Care Act that pay for expanded health insurance under the law The tax was strongly opposed by the $150 billion a year industry that produces everything from catheters to heart stents to artificial joints. In Congress, it was unpopular not only with Republicans but many Democrats from states like Massachusetts and Minnesota with large numbers of medical device companies. Congress voted to suspend the tax for 2016 and 2017 with the widespread expectation it would be permanently abolished before 2018. But various GOP efforts to repeal the Affordable Care Act and the taxes associated with it failed, and the sweeping federal tax overhaul recently signed by President Donald Trump didn't eliminate the medical device tax either. Industry groups Including the Advanced Medical Technology Association (AdvaMed) and the Medical Imaging & Technology Alliance warn the tax will take a $20 billion bite out of the industry over the next decade. "What we have seen from past experience is that it comes out of funding for product development, research and the jobs associated with those things," said J.C. Scott, AdvaMed's head of government affairs. "We fear we will see employment freezes or reductions and a slowdown in the pipeline for medical innovation." The slashing of the overall corporate tax from 35 percent to 21 percent may soften [...]