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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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Trump plan: Less health insurance for lower premiums

By RICARDO ALONSO-ZALDIVAR, ASSOCIATED PRESS WASHINGTON — Feb 20, 2018, 4:49 PM ET The Trump administration Tuesday spelled out a plan to lower the cost of health insurance: give consumers the option of buying less coverage in exchange for reduced premiums. The proposed regulations would expand an alternative to the comprehensive medical plans required under former President Barack Obama's health law. Individuals could buy so-called "short-term" policies for up to 12 months. But the coverage would omit key consumer protections and offer fewer benefits, making it unattractive for older people or those with health problems. The plans would come with a disclaimer that they don't meet the Affordable Care Act's safeguards, such as guaranteed coverage, ten broad classes of benefits, and limits on how much older adults have to pay. Insurers could also charge more if a consumer's medical history discloses health problems. Nonetheless, administration officials said they believe the short-term option will be welcomed by people who need an individual health insurance policy but don't qualify for the ACA's income-based subsidies. Those in this largely middle-class crowd make too much for subsidies and have absorbed years of price hikes. Some say they now face monthly, mortgage-size payments of well over $1,000 for health insurance. Then they usually have to pay a deductible of several thousand dollars. Research indicates the uninsured rate among these customers is growing. "If you are not subsidized, the options can be really unaffordable for folks," Health and Human Services Secretary Alex Azar told reporters. The administration estimates monthly premiums for a short-term plan could be about than one-third of what a comprehensive policy costs. Democrats swiftly branded it a return to "junk insurance," and the main insurance industry lobbying group [...]

California’s two health insurance regulators to investigate Aetna coverage decisions

LA TIMES - By BARBARA FEDER OSTROV- FEB 12, 2018 | 7:50 PM Both of California's health insurance regulators said they will investigate how Aetna Inc. makes coverage decisions, as the lawsuit of a California man who is suing the nation's third-largest insurer for improper denial of care heads for opening arguments Wednesday. The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Aetna after CNN first reported Sunday that one of the Hartford, Conn., company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records — and that was how he was trained by the company, he said. California Insurance Commissioner Dave Jones had already told CNN his office would investigate Aetna, which he reconfirmed in a statement Monday. "If a health insurer is making decisions to deny coverage without a physician ever reviewing medical records, that is a significant concern and could be a violation of the law," Jones said. It isn't known how widespread the review of patient claims by non-physicians is in the industry. The California Department of Insurance, which Jones heads, regulates only a small fraction of the state's health plans, but they include several Aetna policies. He has previously criticized Aetna for "excessive" health insurance rate increases, although neither his agency nor the Managed Health Care Department has the power to stop the increases. Jones' investigation of Aetna will review denials of coverage or pre-authorizations during the tenure of the medical director who testified in the California lawsuit, Jay Ken Iinuma, who [...]

By |February 16th, 2018|Blog, Commercial Insurance, doctor, doctor Credentialing, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing, Staff Training|Comments Off on California’s two health insurance regulators to investigate Aetna coverage decisions

The Future of Healthcare Could Be a Privacy Nightmare

TONIC - Susan Rinkunas -Feb 8 2018, 10:54am The Amazon healthcare effort and CVS-Aetna merger raise lots of questions. Last Tuesday, Amazon, JP Morgan, and Berkshire Hathaway announced that they were coming together to do…something related to healthcare for their 1.2 million employees and could possibly expand to the public. We don’t know whether they’ll provide health insurance, offer health clinics at company buildings and/or Whole Foods stores, or just use their size to negotiate better prices with existing insurance companies. Despite the fact that we have next to zero information about what AmazonCare would actually be, the news still sent healthcare stocks falling and led to optimistic predictions and double-takes from doubters. And it has been freaking me out for the past week. Why? Millions of Americans are hooked on Amazon and its two-day shipping. We use it to order toiletries and home supplies, watch movies, and even get our groceries delivered. The site recommends products to you based on your order history. If the parent company is somehow involved in healthcare, it’s not that hard to imagine a world in which Amazon would use people’s health data to suggest products—or even actively try to stop people from buying “unhealthy” things.Is that imagined scenario something that could actually happen or more Black Mirror territory? I talked to a few privacy and health law experts about Amazon—as well as CVS, since CVS pharmacy and health insurer Aetna announced plans to merge in December. While that deal is still pending, it’s also a privacy minefield of healthcare-meets-retail. Initially, they made me freak out even more, but they also reminded me that there are still a lot of unknowns. I asked Frederik Zuiderveen Borgesius, a privacy researcher [...]

Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

NY Times- By NICK WINGFIELD, KATIE THOMAS and REED ABELSON JAN. 30, 2018 SEATTLE — Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States. The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies. It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses. Major employers, from Walmart to Caterpillar, have tried for years to tackle the high costs and complexity of health care, and have grown increasingly frustrated as Congress has deadlocked over the issue, leaving many of the thorniest issues to private industry. About 151 million Americans get their health insurance from an employer. But Tuesday’s announcement landed like a thunderclap — sending stocks for insurers and other major health companies tumbling. Shares of health care companies like UnitedHealth Group and Anthem plunged on Tuesday, dragging down the broader stock market. That weakness reflects the strength of the new entrants. The partnership brings together Amazon, the online retail giant known for disrupting major industries; Berkshire Hathaway, [...]

By |February 1st, 2018|amazon, Blog, Credentialing, doctor, doctor Credentialing, Health Insurance, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Obamacare, Physician Credentialing|Comments Off on Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care