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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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Why Obamacare Is Still in Peril

NY Times - By THE EDITORIAL BOARD JULY 28, 2017 In a dramatic last-minute spectacle, the latest Republican plan to destroy the Affordable Care Act was defeated early Friday because of the courageous votes of three senators: Susan Collins, John McCain and Lisa Murkowski. This will come as an immense relief to millions of Americans who stood to lose their health insurance, but it would be naïve to think that this is the end of the road for the repeal-Obamacare movement. For the last seven years, Republican leaders have engaged in a fraudulent campaign against the A.C.A. based on the lie that the law is either unworkable or collapsing. The law, which is based on conservative market-based ideas, is certainly flawed and could be improved, but it has helped 20 million people gain insurance and, as a result, provided needed medical care to the poor and the sick. Not only was the Republican diagnosis wrong, but also leaders like the House speaker, Paul Ryan, and the Senate majority leader, Mitch McConnell, tried to push through legislation that was devoid of any ideas and would have weakened the health care system and left millions unable to afford health care. One telling sign: Insurance companies, hospitals, doctors and public interest groups like AARP opposed pretty much every proposal the Republicans put out over the last seven months. Ultimately, this deceitful campaign ran aground by the narrowest of margins in the Senate thanks to the three Republicans and all 48 Democrats and independents. Much attention has rightly focused on Mr. McCain. Returning to the Senate after surgery and a brain cancer diagnosis, he delivered a stirring speech on Tuesday calling on lawmakers from both parties to reach “agreements made [...]

Obamacare and Trumpcare Both Ignore This Massive Underlying Healthcare Issue

Lawmakers are so focused on ensuring people have access to health insurance that they've completely overlooked the root causes of medical care inflation. Sean Williams (TMFUltraLong)  Jul 8, 2017 at 6:49AM Who knew healthcare could be so complicated? Apparently not the president or Congress, as both are struggling to reach a consensus as to what to do with the future of healthcare in America. Obamacare: Should it stay or should it go? Obamacare, which is officially known as the Affordable Care Act (ACA) and was signed into law by Barack Obama in March 2010, has been controversial and mostly disliked since the start. However, it's been successful in reducing the number of people without insurance. The expansion of Medicaid in 31 states, the provision of subsidies for low- and middle-income Americans, and insurance mandates that require member acceptance, regardless of pre-existing conditions, have been crucial in pushing the uninsured rate down to around 9% from 16%, according to data from the Centers for Disease Control and Prevention. At the same time, Obamacare has had its shortcomings. The Shared Responsibility Payment (SRP), which is the penalty consumers pay for not purchasing health insurance, has been far too low relative to the cost of buying an annual health plan, thus fewer young, healthy people have enrolled than expected. The risk corridor, which was a fund designed to provide money to insurers with excessive losses that had set their premiums too low, also sputtered due to insufficient funding. With little in the way of financial protections for insurers, many big names have significantly reduced their ACA plan coverage in 2017 and beyond. There are ways Obamacare can be fixed. These include adjusting the penalty on the SRP upward [...]

Five myths about health insurance…

Washington Post- By Alexis Pozen June 30, 2017 Alexis Pozen is a professor of Health Economics at CUNY School of Public Health and a co-author of the textbook "Navigating Health Insurance. It is no wonder so many myths about health insurance persist. The U.S. health insurance system is opaque and labyrinthine, and at times purposely so. The current debate over whether to repeal major provisions of the Affordable Care Act (ACA), otherwise known as Obamacare, comes down to whether consumers should subsidize services they never expect to use. But who pays for what, and how, is not straightforward. MYTH NO. 1 The ACA has forced millions to buy insurance they don’t want. House Speaker Paul Ryan deployed this myth when defending repeal — which the Congressional Budget Office estimated this past week would increase the number of uninsured people by 22 million by 2026. “It’s not that people are getting pushed off a plan,” Ryan said. “It’s that people will choose not to buy something they don’t like or want.” That reasoning echoes the late Supreme Court justice Antonin Scalia, who during a 2012 challenge to the ACA suggested that the law’s individual mandate started the federal government down a slippery slope. “Everybody has to buy food sooner or later,” he said. “Therefore, you can make people buy broccoli.” And no one wants broccoli, right? But both before and after the ACA, most of the uninsured consistently have reported that they want insurance. In a 2009 Department of Health and Human Services report, 48 percent of uninsured people under age 65 said they didn’t have health insurance because of the cost, 38 percent cited life changes (they had lost their jobs, left school or changed their [...]

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 [...]

New Medicare model for paying doctors passes key test

Credentialing? Let the experts at The Firm Services complete it for you. BY LAUREN CLASON, THE HILL EXTRA - 04/13/17 03:00 PM EDT A far-reaching Medicare payment proposal cleared a crucial hurdle this week, as the federal health program seeks to reward doctors for keeping patients healthy. The pitch from the American College of Surgeons would allow more than 75 different specialty doctors to participate in Medicare’s new value-based payment system. Specialty physicians have been largely left out of the system, commonly known as MACRA after the bill that created it. Doctors would be graded and slotted into four different participation tiers — excellent, good, acceptable and unacceptable. Doctors using a less risky, lower-paying track could only reach the level of “good.” To reach “excellent” and earn bonuses through shared savings, doctors would have to be in the top 10 percent of participants. The surgeons’ group on Tuesday squeaked its proposal past the newly created Physician-Focused Payment Model Technical Advisory Committee, which is reviewing and recommending ideas to Health and Human Services Secretary Tom Price. It didn’t come easy. The surgeons pushed the committee to take a risk in greenlighting the model after the panel expressed significant reservations. The panel had raised questions about a lack of specifics with the software to be used in the program. Members eventually voted to recommend implementation, but only on a limited scale. “We’re all in a learning phase,” Medical Director for Quality and Health Policy Frank Opelka, of the surgeons' group. The model is only the second to earn the committee’s approval. “I feel like we’re building the car while we’re driving it.” The Centers for Medicare and Medicaid Services Innovation Center has approved 11 so-called [...]

UnitedHealth Bets on Medicare, Medicaid After Obamacare Exit

Bloomberg News -Zachary Tracer- April 18, 2017, 8:27 AM PDT UnitedHealth Group Inc. is doing well doing business with the U.S. government. Just not in Obamacare. The company has added more than a million customers in its federally-funded Medicare and Medicaid businesses since Dec. 31, bringing the total in the company’s public programs and seniors unit to 14.9 million, it said in a statement Tuesday announcing first-quarter results. It had a total medical membership of 49.3 million people, even after largely quitting the Affordable Care Act’s markets that many insurers once regarded as a source of millions of new customers. Shares of the biggest publicly traded U.S. health insurer gained 1 percent to $168.90 at 10:50 a.m. in New York. They’re up 31 percent in the last 12 months through Monday’s close. The company has been expanding in Medicare, where it offers private health plans for the elderly, and in Medicaid, where it helps states manage low-income individuals. Those businesses have proven to be more lucrative than Obamacare’s individual market, where UnitedHealth broadly retreated after offering plans on the health law’s exchanges in 34 states last year. The trends in UnitedHealth’s government business will help boost profits. The Minnetonka, Minnesota-based company predicted that earnings for the full year, excluding some items, will be $9.65 to $9.85 a share. That’s well above the $9.51 projected by analysts, according to an average of estimates compiled by Bloomberg, and above the company’s January forecast. First-quarter earnings excluding some items were $2.37 a share, topping the $2.17 average of analysts’ estimates. Distracted Rivals UnitedHealth has also benefited from the entanglement of its major rivals in two massive deals. Humana Inc. and Aetna Inc., the No. 2 and No. 3 sellers [...]

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 [...]