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Summary of Services

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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New Medicare Advantage rules hold big potential for pop health

Healthcare Dive- Meg Bryant- June 13, 2018 The push toward valued-based care and population health management has raised visibility around nonmedical conditions that impact health outcomes. Improving health outcomes using population health strategies could get a major boost with a new Medicare Advantage rule taking effect this week. Payers will now be able to work with companies like Uber or Lyft to provide transportation, for example, as part of a more complete set of benefits for the quickly growing MA population. CMS issued a final rule in May giving MA plans more flexibility in determining the types of supplemental benefits they can offer chronically ill enrollees, including nonmedical benefits. The new policy, part of a broad 2019 Medicare payment rule, means plans like UnitedHealthcare and Humana aren't harnessed to a set palette of supplemental benefits for members with chronic conditions, but can tailor them to the specific needs of individuals. The rule could see an array of new benefits aimed at improving health outcomes by addressing issues such as housing and food insecurity, transportation and social isolation. Potential benefits include ride-hailing services, home visits, nutritional support, air conditioners for people with asthma, home renovations like grab bars and other accommodations to prevent falls, and home health aides. Providers have praised the expansion of benefits. “We now have a funding stream effectively within Medicare Advantage around social services,” Don Crane, president and CEO of America’s Physician Groups (APG), told Healthcare Dive in an interview. He called the change a “necessary and appropriate step” in managing chronic diseases. The focus on social determinants of health and population health management is part of the broader shift to value-based care and reimbursement. Some providers, payers and employers already offer wellness and prevention programs or [...]

ICD-10 follow-up: How is the healthcare system faring?

ICD-10 are you in compliance? Is your credentialing updated? Beckers ACS Review- Written by Mary Rechtoris | February 01, 2016 With the implementation of ICD-10, the number of diagnostic codes increased from 13,000 ICD-9 codes to 68,000 ICD-10 codes. The influx of codes brought a lot of apprehension, and many providers were concerned ICD-10 would cause major delays. Nearly five months later, many healthcare professionals feel the transition went smoothly and cite minimal delays in productivity and reimbursement. Here are 14 things to know: ICD-10 Claims From Oct. 1 to Oct. 27: 1. CMS received a total of 4.6 million claims per day. 2. Two percent of the claims were rejected due to incomplete or invalid information. 3. CMS rejected 0.09 percent of claims due to invalid ICD-10 codes. 4. CMS rejected 0.11 claims due to invalid ICD-9 codes. 5. In total, CMS denied 10.1 percent of processed claims.  Provider response to ICD-10 Navicure, a provider of cloud-based healthcare claims management and patient payment solutions, conducted a post-ICD 10 implementation survey in January 2016. Respondents in the survey included practice administrators or billing managers (59 percent), practice executives (17 percent) and billers and coders (16 percent). The results of the survey are as follows: 6. A reported 99 percent of healthcare organizations said they were prepared for the transition date. 7. Most respondents (60 percent) did not experience any impact on monthly revenue following the ICD-10 transition. 8. Thirty-four percent of respondents have seen revenue fall by up to 20 percent. 9. Nearly half of respondents (45 percent) said their denial rates stayed the same. 10. Forty-four percent saw nominal increases for denial rates between 11 percent and 40 percent. 11. Approximately two-thirds of [...]

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 [...]

Medical Billing – Credentialing- Insurance Claims Processing Management Professionals at The Firm Services

Medical Billing professionals at The Firm Services 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. Outsourcing your billing is advantageous and cost effective, consider the following key points: Minimal set up fee Cost of forms, paper, envelopes, postage, and ink for paper claims Cost and hassle for electronic claims submission Personnel costs to perform billing and fight denials Delays in billing and reimbursements: illness, vacation, unexpected absences, and termination of in-house staff Cost of ongoing training and education for billing personnel (claim and procedure changes), changes in codes, deletion of codes and other billing issues Unlimited, free support to answer questions and guide you The FIRM gives your billing undivided attention. The number one complaint from providers regardless of specialty concerning in house billing, is the billing persons’ constant interruptions, i.e., telephone, chart retrieval, assistance with patients, running off-site errands, filing, copying, faxing, etc. Practice analysis reports provided monthly, additional reports available upon request Remote access to your practices Credentialing Services:  Credentialing for all carriers including all necessary follow up and tracking to completion of process.FIRM CREDENTIALING Medical-Billing-Compliance-Checklist Professional and affordable credentialing to allow you to focus on patient care Reduce your billing issues due to improper credentialing. Changes in your practice or business status effect your reimbursement. The FIRM can identify problem areas and know how to properly execute those changes [...]

MEDICARE NEWS:

Congress Is Poised To Change Medicare Payment Policy. What Does That Mean For Patients And Doctors? Topics: Politics, Medicare, Delivery of Care, Health Costs By Mary Agnes Carey KHN Staff Writer Jan 16, 2014   After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own "doc fix" proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal. Below are some frequently asked questions and answers about the formula – known as the "sustainable growth rate" – and how Congress may change it. Q: What is the sustainable growth rate? A: Known as the SGR, the formula was created as part of a 1997 deficit reduction law designed to rein in federal health  by linking physician payment to an economic growth target. For the first few years after it was created, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since Congress has staved off the scheduled cuts. But each deferral just increased the size – and price tag – of the fix needed the next time. Q: What is Congress doing to scrap the SGR and what would they replace it with? A: Two committees in the House – the Energy and Commerce and Ways and Means panels – and the Senate Finance Committee have passed bills that would repeal the SGR and replace it with a system of rewarding physicians based [...]

OBAMACARE NEWS

Docs, Hospitals Cope With 'Trickle' Of Newly Insured Patients -- But Questions Continue About The Actual Number   Jan 16, 2014 As the Wall Street Journal reports that one of the biggest issues right now is making sure these newly insured people have insurance cards, other news outlets detail reports and questions about the number of enrollees. The Wall Street Journal: Two Weeks Into Health Law’s Rollout, Few Problems, Few Patients Two weeks into the full rollout of the Affordable Care Act, hospitals and doctors say they are coping with the trickle of new patients relatively smoothly, but one of the biggest issues is making sure enrollees get insurance cards. The 2010 health law represented the biggest expansion of insurance coverage in a generation. Nonetheless, the number of people signing up so far for private coverage or Medicaid under the law is still a tiny fraction of all Americans with health insurance, partly because computer snafus hindered early enrollment (Corbett Dooren and Beck, 1/16). The Washington Post’s The Fact Checker: Warning: Ignore Claims That 3.9 Million People Signed Up For Medicaid Because Of Obamacare There is much less to the Medicaid figure than meets the eye. (The exchange figure has been updated recently, to 2.2 million, but not the Medicaid figure.) Indeed, there has been vast confusion about what this figure means, especially in the news media. The Fact Checker cited the 3.9 million figure in a few recent columns, but prodded by an interesting analysis by Sean Trende at Real Clear Politics, we decided to take a closer look (Kessler, 1/16). Kaiser Health News: Capsules: State Snapshots Of Obamacare Enrollment Numbers Enrollment in the health law’s marketplaces surged in December, and the administration’s report on the [...]

AFFORDABLE CARE ACT

Key Features of the Affordable Care Act You will soon have access to health coverage, even if you have a pre-existing condition. And premium tax credits and other financial assistance will help you pay for health insurance if you are eligible. Below are some things you should know about the Affordable Care Act. If you want to get more detailed information about the new health care law, read about each of the provisions. The Health Insurance Marketplace offers a new way to shop and enroll in a health plan. Preventive services will have no out-of-pocket costs. Essential health benefits will be included in most health insurance plans. You can keep your adult children on your health insurance plan up to the age of 26. You choose your doctor. Emergency access is guaranteed. Health coverage is easier to understand. You can appeal if coverage is denied.  

Medical Billing ? Credentialing? The Firm Services has your answers.

Our mission is to provide professional, state of the art medical billing and specialty services to our clients to achieve maximum reimbursement. 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. FIRMSERVICESMEDICALBILLINGINSURANCECLAIMSThe 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 as effective denial appeals. Continuing Education at The FIRM is the key to understanding and keeping abreast of the continuously changing federal and State laws & regulations that can affect our clients. The FIRM serves physicians and physicians groups nationwide in all medical specialties including; Audiology Cardiology Chiropractic DME Family Practice Internal Medicine Neurology Occupational Therapy and Speech Language Pathology Pain Management Plastic Surgery Physical Therapy Podiatry Mental health Radiology Pain Management The Firm offers premier expertise, services, resources, and support for: CREDENTIALING AND CONTRACTING Medicare / Medicaid, Blue Cross Blue Shield, Cigna, UHC, Multiplan, Humana, Aetna, Coventry, Scott & White The FIRM understands the importance of proper credentialing and contracting and how it impacts your income. Through the years, building strong relationships with many insurance companies and provider enrollment representatives across the country, The FIRM can help you the provider save valuable time and money during the credentialing process. *NPI PROFILE Group or Individual An accurate and updated NPI Profile is critical to Medicare enrollment and payments. *CAQH An updated [...]

They Are Warriors of All Things Medical

Stacy King wrote a great article about The FIRM, take a look:

Listen Up, Doctors – You Really Need to Know This

Listen Up, Doctors—You Really Need to Know This The Buck Starts Here! By Cara Smith And that goes for you, too, dentists, optometrists, podiatrists—indeed, all healthcare professionals, whether you’re an average medical practice, urgent care facility, or large multi-specialty clinic; or a solo practitioner just starting out. Chris and Tia Aspra, who, along with partner Pam Kendricks, own and operate the medical billing,  credentialing, and consulting powerhouse that is The FIRM, have some critical words of wisdom about insurance credentialing—that murky, agonizing quagmire—that they really want you to hear. First, though, it’s worth pointing out just how important insurance credentialing really is, and what makes The FIRM so great (in addition to their flexed up resources and decades of combined experience, of course). It’s quite simple, explains Tia. “Credentialing—that is, your contracts with insurance companies—directly impacts your collections. If there’s a problem, you won’t be able to collect,” she says. “We realized long ago that billing and credentialing were inextricably linked, and that’s why we created The FIRM. We all understand both processes, which is what allows us to get maximum results for our clients.” With that in mind, let’s turn to some all-important truths about credentialing Tia would like to share, starting with the first: credentialing is extremely complicated. “All too many providers think it’s a mere matter of sending a few faxes,” says Tia. In fact, it’s a multi-stage, multi-tiered process, which needs to be done correctly and tracked meticulously every step of the way; even worse, every insurer has different requirements. In other words, your office manager, no matter how competent, may soon be in over her head. “We make sure nothing falls through the cracks,” says  Tia. “And while we can’t [...]

By |January 12th, 2013|Dentist, Doctor, Healthcare Professionals, Medical Credentialing, Multi-Specialty, Podiatrist, Press|Comments Off on Listen Up, Doctors – You Really Need to Know This