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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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Major Changes May Be Coming to Medicare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services Published: Thursday, April 13, 2017 11:19 p.m. CDT • Updated: Thursday, April 13, 2017 11:19 p.m. CDT By Trudy Lieberman, Rural Health News Service What’s going to happen to Medicare? That’s not an insignificant question given the political shift in Washington. Now, with Republicans controlling the presidency and both houses of Congress, some ideas they’ve been pushing for years have a chance of passing. Those ideas would drastically change the way Medicare works for those already on it and those joining in the next few years. Medicare is wildly popular, but that popularity doesn’t necessarily translate into understanding of a very complex program, what’s happened to it, and what may happen. Writing about Medicare for nearly 30 years and watching it evolve, I’ve seen how easily Congress has already made big changes with hardly a peep from the press or the public. The same could happen again. In this column, I discuss a few of those possible changes gleaned from my decades of experience covering the program. Since the election, there’s been talk of “voucherizing” or privatizing Medicare, an idea Republicans have been pushing for 20 years. Under a fully privatized arrangement, Medicare would no longer be social insurance like Social Security but more like Obamacare with everyone eventually buying their coverage from private insurance companies. Beneficiaries would receive a sum of money, likely to be called “premium support” instead of the more dire-sounding “voucher,” to help buy their coverage. The amount of support and how well it would keep pace with medical inflation would be buried in the details Congress would hash out. Today, the government provides the benefits [...]

One in four U.S. consumers have had their personal medical information stolen

The Accenture study also finds that half of these victims were subject to medical identity theft and on average had to pay $2,500 in out-of-pocket costs per incident. Healthcare IT News - By Bill Siwicki February 20, 201708:23 AM Twenty-six percent of U.S. consumers have had their personal medical information stolen from healthcare information systems, according to results of a new study from Accenture released today at HIMSS17 in Orlando. The findings show that 50 percent of those who experienced a breach were victims of medical identity theft and had to pay approximately $2,500 in out-of-pocket costs per incident, on average. In addition, the survey of 2,000 U.S. consumers found that the breaches were most likely to occur in hospitals (the location cited by 36 percent of respondents who experienced a breach), followed by urgent-care clinics (22 percent), pharmacies (22 percent), physicians’ offices (21 percent) and health insurers (21 percent). 50 percent of consumers who experienced a breach found out about it themselves, through noting an error on their credit card statement or benefits explanation, whereas only 33 percent were alerted to the breach by the organization where it occurred, and only 15 percent were alerted by a government agency, according to the survey. Among those who experienced a breach, 50 percent were victims of medical identity theft, the survey found. Most often, the stolen identity was used to purchase items (cited by 37 percent of data-breached respondents) or used for fraudulent activities, such as billing for care (37 percent) or filling prescriptions (26 percent). Nearly one-third of consumers had their social security number (31 percent), contact information (31 percent) or medical data (31 percent) compromised, according to the survey. Unlike credit card identity theft, where [...]

After Two Megadeals Blocked, Health Insurers Plot Next Moves

Bloomberg- by Zachary Tracer , David McLaughlin , and Andrew M Harris February 8, 2017, 4:05 PM PST February 9, 2017, 2:37 PM PST After 18 months of courtship and court cases, two massive deals that would have reshaped the U.S. health insurance industry have both been declared dead, blocked by judges who said they’d do unacceptable harm to competition in the industry. Now, the companies are right back where they started. Anthem Inc.’s $48 billion deal to buy Cigna Corp. was blocked by a federal judge late Wednesday, weeks after another judge halted Aetna Inc.’s bid for Humana Inc. Anthem filed a notice of appeal on Thursday, and Aetna and Humana have said they’re still deciding whether to appeal. The question now becomes what the companies will do with the large piles of cash they allocated for the acquisitions, and whether they’ll try anew at fresh takeovers under a Trump administration, whose antitrust officials could be more amenable to large consolidations. They could also opt for something more conservative in the face of widespread uncertainty about the future of the U.S. health system. But first, they may be back in court. “Anthem is significantly disappointed by the decision,” Chief Executive Officer Joseph Swedish said in a statement. “If not overturned, the consequences of the decision are far-reaching and will hurt American consumers.” Cigna, for its part, said it “intends to carefully review the opinion and evaluate its options in accordance with the merger agreement.” CEO David Cordani has estimated that his company will have $7 billion to $14 billion of deployable capital, with the high end including extra debt the company could take on if it decided to make acquisitions. “We have a track record [...]

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 [...]

Donald Trump’s promises are taking a beating in the GOP’s Obamacare replacement

Questions? Call the Professionals at The Firm Services. Washington Post - By Aaron Blake March 10 at 10:29 AM Two big stories on the Republicans' Obamacare replacement bill broke late Thursday. And both point to major broken promises for President Trump. The Washington Post's Katie Zezima and Christopher Ingraham report that the bill would cut a mental-health and addiction treatment mandate covering 1.3 million Americans — counter to a Trump promise to expand treatment: The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide. Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans. CNN, meanwhile, is reporting that the Trump White House is negotiating to possibly roll back the Medicaid expansion earlier to appeal to conservatives — counter to Trump's promise to leave Medicaid alone: White House officials are beginning to urge House GOP leadership to include an earlier sunset of the Medicaid expansion funds authorized under Obamacare than the 2020 date set by the current bill. The change comes just days after the bill was unveiled and follows a blitz of activism aimed squarely at the White House and President Donald Trump, who has met with conservative leaders in recent days. Here's what Trump said last year: “I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid.” After House Republicans released a proposal to transform the Affordable Care Act, members of [...]

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 [...]

Trump urges insurers to work together to ‘save Americans from Obamacare’

Will Obamacare survive? Washington Post - By Carolyn Y. Johnson and Juliet Eilperin February 27 at 12:19 PM  President Trump met with major health insurers Monday morning, in the midst of political divisions over how to dismantle and replace President Obama's signature health-care law, the Affordable Care Act, and intensifying public pressure to preserve the policy. The meeting included leaders from Blue Cross Blue Shield, Cigna, Humana, UnitedHealth Group, Aetna, Anthem, Kaiser Permanente and the industry lobbying group, America's Health Insurance Plans. "We must work together to save Americans from Obamacare," Trump said in public remarks before the closed-door meeting. He criticized the Affordable Care Act, commonly known as Obamacare, for creating minimal health coverage requirements that restricted the types of plans insurers could sell. "Obamacare forced providers to limit the plan options they offered to patients and caused them to drive prices way up," Trump said. "Now a third of U.S. counties are down to one insurer, and the insurers are fleeing. You people know that better than anybody." Over the past month, more insurers have warned that they could pull out of the Affordable Care Act’s health-care exchanges where individuals can buy government-subsidized insurance. Aetna chief executive Mark Bertolini has described the exchanges as being in a "death spiral." Humana — which insures about 150,000 people on the exchanges this year — announced in mid-February it would exit the exchanges in 2018. In an earnings call, Molina Healthcare disclosed that its exchange business lost $110 million in 2016 and said it would evaluate its participation for next year on a state-by-state basis. A Molina spokeswoman said the company, which insures 1 million members through the exchanges, was not invited to the meeting. Trump gave [...]

The Trump administration just proposed big changes to Obamacare

Will Obamacare survive? Business Insider- Feb. 15, 2017, 9:54 AM- Bob Bryan The Centers for Medicare and Medicaid Services on Wednesday morning announced new proposed rules for the Affordable Care Act's individual insurance exchanges. The proposals from CMS include several changes to enrollment periods and timelines for insurers in an attempt at "stabilizing the individual and small group health insurance markets," according to a press release. The proposed changes would be the first administrative tweaks to the law, also known as Obamacare, under President Donald Trump's administration. They contain a combination of long-considered ideas and serious departures from the previous administration. Perhaps the two most striking proposed changes are cutting in half the exchanges' 2018 open enrollment period and lowering minimum standards for care to qualify for the exchanges. The CMS proposes an open enrollment period — during which people without health insurance through their employer or Medicaid/Medicare can sign up for coverage — from November 1 to December 15, 2017. Open enrollment periods have been three months, from November 1 to January 31. Additionally, the rules would lower the "de minimis range used for determining the level of coverage," according to the release. Essentially, the ACA established minimum standards for coverage (here's a full breakdown from CMS) in order to be certified on the bronze, silver, and gold plan levels. The new rule would allow insurers to cover slightly fewer areas of health and still be at a certain metal level. The CMS projects the rules would result in increased out-of-pocket costs for Americans in the short term but that lower premiums would offset this in the long run. "The proposed change in [actuarial value] could reduce the value of coverage for [...]

As Obamacare Repeal Stalls, Republicans Face New Challenges

Will Obamacare survive? NBC News - Benjy Sarlin -FEB 8 2017, 9:55 AM ET President Donald Trump caused a stir when he suggested Sunday that the Republican Party's quest to repeal and replace the Affordable Care Act might continue through 2018. But some Republicans think he might be on to something. "I know there was some hyperventilating about the president's comments that this could spill into next year, but that didn't bother me," Rep. Charlie Dent, R-Pennsylvania, said as he left a caucus meeting Tuesday. "I thought it was fairly realistic." "I do think slowing down would be wise," Rep. Tom MacArthur, R-New Jersey, told NBC News when asked about Trump's comments. Trump's remarks come as efforts to repeal and replace the Affordable Care Act, which began with a bang after the election, are lagging amid internal debates over the substance of a Republican health care plan and the process used to pass it. The current plan is a delicate multi-step path that requires Republicans to use the budget reconciliation process to partly repeal Obamacare by a majority vote and install some elements of a Republican plan, then negotiate with Democrats later on a full replacement, which would require 60 Senate votes. Republicans can't manage many defections — they have only 52 votes in the Senate — and consensus has so far been elusive. On one hand, conservatives are eager to fulfill the Republican Party's longtime promise to repeal the law and replace it with a less expensive plan with fewer taxes and more free-market principles. On the other hand, more moderate Republicans are concerned that removing too much of the law too fast could wreck the insurance market and that some conservative [...]

Doctors Make the Case for Obamacare or Something Like It

Will Obamacare survive? NBC News -HEALTH- Maggie Fox -FEB 2 2017, 6:20 PM ET Congress should improve Obamacare without taking away what's best about it, doctors said Thursday. Doctors who treat women and children, as well as general practitioners, made a daylong dive across Senate offices to make the case for keeping important aspects of the Affordable Care Act. And they rebuked Republicans in Congress for talking up repeal without having a plan for replacement in place. "Currently insured individuals should not lose their coverage as a result of any action or inaction by policymakers," five medical organizations said in a statement released as part of the lobbying push. "Acceptable reform must continue to ensure access to comprehensive, safe, and affordable care," said Dr. Thomas Gellhaus, president of the American Congress of Obstetricians and Gynecologists. The GOP has vowed to repeal and replace the 2010 Affordable Care Act, former president Barack Obama's signature policy. But since they took firmer control of the Senate, kept control of the House and seated Republican President Donald Trump in the White House, they've faltered, quarreling about how to move ahead. “Potential changes in federal Medicaid funding should not erode benefits, eligibility, or coverage compared to current law.” It doesn't help that the law's become more popular in the polls. Republicans do not want to pull the rug out from under the 20 million people who have gotten health insurance under the law, either on the exchanges where they can buy private insurance, often with a federal subsidy, or through expansions of the Medicaid program. "We didn't hear from anyone who said we want to have the 20 million people who have gained coverage under the Affordable Care [...]