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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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Poll: Most older Americans want Medicare to cover long-term care

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services CBS News- AP / May 26, 2017, 7:44 AM WASHINGTON -- A growing number of Americans age 40 and older think Medicare should cover the costs of long-term care for older adults, according to a poll conducted by the Associated Press-NORC Center for Public Affairs Research. That option is unlikely to gain much traction as President Donald Trump's administration and Republicans in Congress look to cut the federal budget and repeal President Barack Obama's 2010 health care law. Most older Americans mistakenly believe they can rely on Medicare already for such care, the poll shows, while few have done much planning for their own long-term care. Things to know from the AP-NORC poll of older adults: MOST WANT MEDICARE TO PAY More than half of older Americans - 56 percent - think the federal government should devote a great deal or a lot of effort to helping people with the costs of long-term care, and another 30 percent think it should make a moderate effort to do so. According to the poll, 56 percent of Americans age 40 and over think Medicare should have a major role in paying for ongoing living assistance, up from 39 percent who said so in 2013. Majorities of both Democrats and Republicans now think Medicare should bear a large part of the burden. The poll has other signs of growing support for government involvement in providing long-term care. Seventy percent of older Americans say they favor a government-administered long-term care insurance program, up from 53 percent who said so a year ago. Most also favor tax policies to encourage long-term care planning, including tax breaks [...]

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 [...]

How to improve queries for ICD-10 claims

by CARL NATALE  OCT 28, 2015 - 05:51 AM U.S. healthcare is waiting to see how ICD-10 implementation affects reimbursements. The fear is that ICD-10 claims will be denied at a greater rate than before Oct. 1 — either by design or error. And that is going to trickle down to physicians in the form of queries. And if a medical practice wants to avoid an increase in denials, it needs to help physicians provide more clinical detail to support the proper ICD-10 codes. That will most likely come in the form of queries. Do you really need to query? But medical coders need to make sure they really need to query. Pamela Haney lists four tests of whether an ICD-10 query is needed: Does the medical record contain conflicting information? Are there elements or information missing from the medical record? Are there conditions or procedures that need more detail to support a specific ICD-10 code? If there is an unspecified diagnosis, is there information that suggests a more specific diagnosis is possible? The Journal of AHIMA published guidelines that explain writing a query is needed when clinical documentation: "Is conflicting, imprecise, incomplete, illegible, ambiguous or inconsistent" Describes clinical indicators that don't clearly support the underlying diagnosis Includes clinical indicators, evaluation, and/or treatment that does not seem related to any medical condition or procedure Does not support or validate a diagnosis Does not support the present on admission indicator If you have to query Review some quidelines on how to write better queries for information that supports ICD-10 coding: Be written in clear, concise and precise language Contain evidence specific to the case Be non-leading Be part of the clinical documentation Include ICD-10 language But [...]

What’s left to do in the week before ICD-10 coding goes live?

The Firm Services can help your office get ready for ICD-10 by CARL NATALE  SEP 23, 2015 - 12:00 AM There's only a week left before you have to start using ICD-10 codes. That's not a lot of time to do much. Earlier this month, we published an ABC checklist with last minute ICD-10 implementation tips for procrastinating physicians from the Centers for Medicare and Medicaid Services (CMS). It focused on: Assess systems Be sure everything is ready Contact vendors For medical practices that started preparations sooner than this month, there are still some last minute steps. Nelly Leon Chisen writing for Hospitals & Health Networks offers some ideas to add to healthcare providers' ICD-10 check lists: Create a communication plan to report problems. Who gets contacted? How to update everyone. Who to contact at health plans, clearinghouses and vendors for information and help Review contingency plans What is the status of ICD-9 coding backlogs? What will it take to clear them? Test medical coders' skills Plan quick refreshers Assess ICD-10 coding accuracy If you're billing software isn't going to cut it, CMS has these suggestions for patching Medicare billing problems: Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC); In about half of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal; Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met. Those ideas should be considered temporary until medical practices get things ironed out with healthcare vendors.[ICD10Watch Poll: Are your vendors ready for Oct. 1?]Even with good plans in place, things could get tense next week. Rebecca Fox, MD, has some ideas for helping medical practices work through the stress [...]

ICD-10 hops Congressional hurdle

The Firm Services can help your office get ready for ICD-10 Congress will have just 17 week days to pass legislation killing the conversion. Is ICD-10 finally in the clear? Tom Sullivan, Editor-in-Chief, Healthcare IT News- August 10, 2015 Health IT professionals and policy wonks sleeping with one eye open while watching Capitol Hill for clues about ICD-10's fate can rest easy – at least for now. Congress kicked off its vacation on Monday and, in so doing, effectively hit a pause button of sorts: Before the U.S. Senate and House of Representatives return on September 8 there will not be any legislative action to delay or kill ICD-10. None. Just don't mistake the midsummer truce that the Centers for Medicare & Medicaid Services made with the American Medical Association as any type of guarantee. That was not an act of Congress and insofar as public knowledge goes, CMS was operating under its own recognizance when it agreed to that treaty. What's more, critics say the concessions – CMS won't deny erroneous claims so long as they are submitted in ICD-10 for the first year – are nice but not enough. It doesn't help, either, that the seminal readiness survey conducted by WEDI (Workgroup for Data Interchange) and published just last week found that 10 percent of providers and approximately half of medical practices are unsure whether they'll be ready on time. Yes, the other 90 and 50 percent, respectively, indicated they would meet the mandate, but those who might not triggered enough concern for WEDI to caution that claims disruptions might accompany the transition. The thing about Congressional timing, though, is that Senators and Representatives will have just 17 week days in [...]

CMS Announced Proposed Rule on the FY16 Medicare Physician Fee Schedule

Credentialing, Revalidation Services professionals at The Firm Services In a press release issued on July 8, the Centers for Medicare and Medicaid Services (CMS) announced its Proposed Rule on the FY16 Medicare Physician Fee Schedule (PFS). This Proposed Rule represents the first update to the PFS since the repeal of the Sustainable Growth Rate (SGR) update methodology earlier this year. Andy Slavitt Administrator of CMS stated “CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care. Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people.”The proposed CY 2016 PFS rule includes but is not limited to the following updates: Payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes Physician Quality Reporting System Physician Value-Based Payment Modifier CMS is requesting comments by Aug. 31, 2015 on the following: Implementation of certain provisions of the MACRA, including  the new Merit-based Incentive payment system Potential expansion of the Comprehensive Primary Care Initiative The Proposed Rule was published today in the Federal Register and can be accessed by clicking here. Questions about 2016 Medicare Fee Schedules or ICD -10 ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or credentialing@thefirmservices.com 

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

Medicare ICD-10 Questions? We have answers at The Firm Services July 6,2015 CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” “ICD 10 [...]

How Doctors can really cut costs for medicare patients.

The best use of Medicare Oversight? Follow the Real Money Physicians are eyeing the wrong procedures in the quest to cut costs for Medicare patients. By Mark Pauly May 15, 2015 | 4:15 p.m. EDT Physicians have, of late, played an amazingly small role in guiding health policy. They had little to say or do with health insurance reform, which was the major focus of the Affordable Care Act. But to some extent, they have been trying to get on the right side of history by expressing concern about growing medical care spending and identifying services they control or sell that might be eliminated. The "Choosing Wisely" campaign, for example, has recruited physician specialty societies to compile lists of medical treatments that they were formerly choosing unwisely. No one could question efforts to deter care that is harmful or a waste of time. But if physicians expect to enlist consumers and insurers in this campaign, it would help if doctors were doing more than criticizing what other doctors do. It would help if their criticism was based on evidence of actual patterns of care observed in large data sets and if the reasons for such criticism could be well-identified. It would also help if changing the practices they criticize might lead to saving some serious money. The most recent example of physician efforts to document low-value care is a study reported last month in the New England Journal of Medicine, titled "Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery." Cataract surgery, to replace a clouded lens in the eye, is the most common elective surgical procedure for elderly people; it is a safe and effective way to improve vision and is usually performed by an [...]

Supreme Court saves Obamacare

Physicians Credentialing Services By Ariane de Vogue and Jeremy Diamond, CNN Washington (CNN) Obamacare has survived -- again. In a 6-3 decision, the Supreme Court saved the controversial health care law that will define President Barack Obama's administration for generations to come. The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage. "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all," Obama said from the White House. "The Affordable Care Act is here to stay" In a moment of high drama, Chief Justice John Roberts sent a bolt of tension through the Court when he soberly announced that he would issue the majority opinion in the case. About two-thirds of the way through his reading, it became clear that he again would be responsible for rescuing Obamacare. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter." READ: John Roberts' big moment: Will he anger conservatives again? He was joined by Justice Anthony Kennedy -- who is often the Court's swing vote -- and the four liberal justices. Justice Antonin Scalia wrote [...]

BILL HR4302 PASSES, ICD-10 IMPLEMENTATION DELAYED UNTIL OCT 1, 2015

         On April 1, President Obama signed into law a bill to delay the planned ICD-10 implementation until Oct. 1, 2015. Specifically, the bill prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until Oct. 1, 2015. Details on implications to providers, health plans and technology companies in the health care industry are as yet unclear. Availity remains confident that we are prepared to accommodate any scenario that could unfold. We are committed to helping you operate a healthy, thriving business—even in an industry constantly redefined by change. Because we have solid yet flexible contingency plans for ICD-10 and other programs, you and your business will have the support you need. We are committed to preserving the uninterrupted flow of your administrative, clinical and financial information exchange on our networks, to assure continuous cash flow to your business. The Firm believes successful Physicians view their office as a business. In order to meet today’s healthcare needs of the patient, profits are critical for a Medical Practice to survive and thrive. As a trusted intermediary between payers, providers and other industry partners, the decision to delay the ICD-10 implementation will cause businesses to rethink their plans. As we consult with payers about their strategies, we will advise you on potential impacts to testing, training and implementation as soon as possible. The FIRM, with 30 years of combined experience specializes in Medical Billing, Credentialing and Consulting services to assist physicians and their staff to operate a more efficient, compliant and profitable medical practice. At The FIRM, optimal insurance reimbursement is our goal! The Firm’s expert medical billing staff understands the importance of excellent and efficient medical billing and collections as well [...]