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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 administration proposes new Medicare drug payment model to reduce costs

HEALTHCARE FINANCE- Susan Morse, Senior Editor October 25,2018 The International Pricing Index model would reset Medicare payments for physician-administered drugs. President Trump on Thursday proposed to reduce prescription drug costs in a move projected to save taxpayers and patients $17.2 billion over five years. America's Health Insurance Plans commends the proposed payment model, while the American Medical Association voiced more caution. Under the proposed International Pricing Index model, Medicare's payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries. The move from current payment levels to payment levels based on international prices would be phased in over a five-year period, would apply to 50 percent of the country, and would cover most drugs in Medicare Part B, which includes physician-administered medicines such as infusions, according to the Department of Health and Human Services. HHS said it is considering a randomized approach to determine which geographies in the country would participate. The Centers for Medicare and Medicaid Services is taking comments prior to issuing a proposed rule in the spring of 2019, with a potential start in spring 2020. WHY THIS MATTERS HHS contends the model would correct existing incentives to prescribe higher-priced drugs and, for the first time, address disparities in prices between the United States and other countries. Since patient cost sharing is calculated based on Medicare's payment amount, patients would see lower costs under the model, HHS said. TREND Physicians currently purchase the drugs they administer and receive payment from Medicare at an amount equal to the average sales price plus an add-on fee. The add-on is calculated as a percentage of the average sales price of the drug. This creates several problems, HHS said. First, [...]

By |October 26th, 2018|Blog, Consulting, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on Trump administration proposes new Medicare drug payment model to reduce costs

Medicare Advantage organizations overturned 75% of their denials, fed investigation shows

Beckers Hospital CFO Report- Written by Kelly Gooch | October 02, 2018 A recent investigation by the U.S. Office of Inspector General found between 2014 and 2016, Medicare Advantage organizations overturned 75 percent of their preauthorization and payment denials upon appeal. The OIG's report, released in September, found Medicare Advantage organizations overturned about 216,000 denials annually during the period. Investigators also found that independent reviewers overturned more denials at higher Medicare Advantage appeals levels. "The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided," the agency wrote. "This is especially concerning because beneficiaries and providers rarely used the appeals process, which is designed to ensure access to care and payment.  During 2014-16, beneficiaries and providers appealed only 1 percent of denials to the first level of appeal." In addition to the numbers of overturned denials, persistent performance problems related to Medicare Advantage organizations were identified by CMS audits, according to the OIG. Investigators said one example is CMS citing 56 percent of audited contracts for making inappropriate denials in 2015. They said 45 percent of contracts were also cited for providing incomplete or incorrect information in denial letters. The OIG recommended CMS step up oversight of Medicare Advantage contracts, "including those with extremely high overturn rates and/or low appeal rates and take corrective action as appropriate" and offer beneficiaries easily accessible information about serious violations by Medicare Advantage organizations. CMS agreed with the recommendations. Questions about Medicare, private Medical Insurance and health insurance reimbursement? Physician Credentialing and Revalidation? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844

By |October 4th, 2018|Blog, Credentialing, Doctor, doctor, doctor Credentialing, Health Insurance, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on Medicare Advantage organizations overturned 75% of their denials, fed investigation shows