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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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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 [...]

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 [...]

Tax bill will not seek repeal of individual health insurance mandate

The Hill- BY PETER SULLIVAN - 11/02/17 09:51 AM EDT The tax reform bill to be released Thursday will not include a repeal of ObamaCare's individual mandate, sources say, despite President Trump proposing the idea on Wednesday. Repealing the mandate would introduce a whole new area of controversy into the bill, and many Republicans think tax reform is hard enough without adding in health care. Still, it is possible the idea could come back down the road, given that some Republicans are still pushing. Rep. Kristi Noem (R-S.D.), a member of the House Ways and Means Committee, said Wednesday night that she did not think mandate repeal would be included "just because we didn't have unanimous agreement on the committee." Sen. Tom Cotton (R-Ark.) has been the main proponent of the idea and talked with Trump about it over the weekend. Repealing the mandate would save around $400 billion, which could be used to help pay for tax cuts, but the Congressional Budget Office also says 15 million more people would be uninsured and premiums would rise 20 percent. Ways and Means Committee Chairman Kevin Brady (R-Texas) said earlier this week, though, that he did not want to include mandate repeal because he fears it will jeopardize the tax bill since the Senate has been unable to deliver on health-care reform. Rep. Mark Meadows (R-N.C.), the chairman of the conservative House Freedom Caucus, said Wednesday night that he would push for including mandate repeal and that he thought "ultimately" it would be included in the bill. Meadows said he has talked to Cotton. Rep. Mark Walker (R-N.C.), the conservative Republican Study Committee chairman, said he had discussed the idea at an RSC meeting with National Economic [...]

By |November 2nd, 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 Tax bill will not seek repeal of individual health insurance mandate

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 [...]

Will Congress Continue Health Care For 9 Million Children?

NPR- September 6, 20175:38 PM ET- PHIL GALEWITZ A popular federal-state program that provides health coverage to millions of children in lower- and middle-class families is up for renewal Sept. 30. But with a deeply divided Congress, some health advocates fear that the Children's Health Insurance Program could be in jeopardy or that conservative lawmakers will seek changes to limit the program's reach. Other financial priorities this month include extending the nation's debt ceiling, finding money for the Hurricane Harvey cleanup and keeping the government open. "With all that is on Congress' plate, I am very worried that a strong, wildly successful program with strong public support will get lost in the shuffle and force states to begin the process of winding down CHIP," said Bruce Lesley, president of the advocacy group First Focus. The program covers more than 9 million kids — typically from families not poor enough to qualify for Medicaid, the state-federal program that covers health care for people with low incomes. Income eligibility levels for CHIP vary widely among states, though most set thresholds at or below 200 percent of the poverty level — about $49,000 for a family of four. Unlike Medicaid, CHIP is usually not free to participants. Enrolled families pay an average premium of about $127 a year. Since CHIP's enactment, the share of uninsured children in the U.S. fell from 13.9 percent in 1997 to 4.5 percent in 2015, according to the Medicaid and CHIP Payment and Access Commission. The 20-year-old program has bipartisan support. One of its original sponsors is Sen. Orrin Hatch, R-Utah, chairman of the Finance Committee, which has scheduled a hearing on reauthorization Thursday. It's possible in the jam-packed legislative calendar this month that other [...]

States hurry to fix health-insurance markets

The Economist- Aug 31st 2017 | WASHINGTON, DC Though insurers remain, Obamacare is teetering in places NOT long ago, America’s health-insurance markets seemed to be drying up. In June 49 counties lacked any willing providers for the “individual market”, which serves 18m Americans who are not covered by an employer or the government. The Affordable Care Act, Barack Obama’s health-care law, seemed to have failed these places. Frantic efforts by state officials have filled the gaps: Nevada’s governor claims to have interrupted a hiking trip with his daughter to broker a deal covering most of his state. The last empty market, in Ohio, gained an insurer on August 24th. But failure has not yet been averted. With health reform stalled in Congress, several states are rushing to patch things up themselves before insurance for 2018 goes on sale in November. Obamacare’s markets were always likely to limp on rather than collapse utterly, because they have a blank cheque from the federal government. The law caps premiums for buyers who earn less than four times the poverty line (this year the cut-off is $48,240 for an individual). No matter how high premiums rise and how many healthy people leave the market, some subsidised enrollees, who have already reached their premium caps, will keep buying. The only surprise is that it has taken so much cajoling to get insurers to run monopolies in markets buttressed by such generous government support. Yet rising premiums are a big problem for many of the 9m Americans who buy insurance for themselves without any government help. In Iowa about 28,000 people are on the hook, according to Doug Ommen, the state’s insurance commissioner. As things stand, only one firm, Medica, will sell [...]

House Passes Measure to Repeal and Replace the Affordable Care Act

NY Times- By THOMAS KAPLAN and ROBERT PEAR MAY 4, 2017 WASHINGTON — The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage. The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement. The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch. “To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.” Even before the vote, some Republican senators had expressed deep reservations about one of the most important provisions of the House bill, which would roll back the expansion of Medicaid under the Affordable Care Act. With $8 Billion Deal on Health Bill, House G.O.P. Leader Says ‘We Have Enough Votes’ MAY 3, 2017 But a softening of the House bill, which could help it get through the Senate, would present new problems. For any repeal measure to become law, the House and the Senate would have to agree on the language, a formidable challenge. The House voted on Thursday on a revised health care bill that would [...]

Modernizing Medicare with the QPP

Let the Experts at The Firm Services assist your practice. HBMA- Dr. Kate Goodrich- 03/13/2017 Modernizing Medicare with the QPP Keeping Medicare’s Promise to Families Today and Tomorrow By Kate Goodrich, Centers for Medicare & Medicare Services (CMS), US Department of Health and Human Services (HHS) Billing managers are uniquely positioned to support clinicians in succeeding under the new program. For example, you can assist physician and other clinical practices in: Determining whether they need to participate in the Quality Payment Program (QPP); Verifying whether they meet desired thresholds in terms of Medicare fee-for-service (FFS) patient counts and billing amounts; Examining the potential impact of various participation options on revenue; and Analyzing CMS feedback on cost performance measures. And, for clinicians who don’t believe they’re prepared to participate, you can help them understand that CMS offers flexible options. We understand that resources and technology vary widely across practices, and we want the broadest participation possible among eligible clinicians. I look forward to continuing to work with the entire healthcare community as we embark on the implementation of the QPP. Background In October 2016, HHS launched the QPP with a final rule with comment period implementing certain provisions of MACRA – the Medicare Access and CHIP Reauthorization Act of 2015. A bipartisan solution, MACRA ended the flawed Sustainable Growth Rate (SGR) formula for Physician Fee Schedule payments, and streamlined existing Medicare quality reporting programs. MACRA was enacted to strengthen Medicare. Clinicians who participate in Medicare are part of a dedicated team that serves 55 million of our country’s most vulnerable Americans. As a result of the SGR formula, physicians and other clinical practices faced payment cliffs for 13 years. The QPP improves Medicare by [...]

The Advantages and Disadvantages of Electronic Medical Records

Credentialing, Revalidation Services professionals at The Firm Services Crystal Lombardo- The Next Galaxy  The advancement of technology has changed the way the entire world functions. One big change that has happened has to do with the medical world. Electronic medical records, or EMR’s, are used in just about every single hospital and doctor’s office in the United States. Electronic medical record means that a patient’s paper chart, which is what contains all of their medical history, information on medical conditions, treatments, and other types of information, are all stored electronically. It has been a great asset to the medical community, but has brought some pretty hefty issues right along with it. Advantages of Electronic Medical Records 1. Instant Access is an Advantage EMR give medical professionals quick and simple access to all of the patient information that they may need in order to provide an accurate and speedy diagnosis. Much of the confusion, and bureaucratic characteristics of the medical world are eliminated with the use of electronic medical records. 2. Doctor’s Have Bad Handwriting It is no secret that the majority of doctors have pretty illegible penmanship. This has been a problem that has haunted the medical world for decades. Electronic medical records have solved this problem! Doctors no longer have to scribble notes that may not be able to be read, instead they type them into the electronic medical record database, so there is never anymore confusion about if that is an “r” or a “z”. 3. Record Keeping Has Been Cleaned Up Keeping a physical record for each patient can begin to take up a pretty intense amount of space. Boxes and boxes of records are filed in order to be [...]