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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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CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients

cms.gov- November 01,2018 CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients Changes to the Medicare Physician Fee Schedule and Quality Payment Program will shift clinicians’ time from completing unnecessary paperwork to providing innovative, high-quality patient care. Today, the Centers for Medicare & Medicaid Services (CMS) finalized bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule released today also modernizes Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services, no matter where they live. It makes changes to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes. Today’s rule also updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade. “The historic reforms CMS finalized today move us closer to a healthcare system that delivers better care for Americans at lower cost,” said Health and Human Services (HHS) Secretary Alex Azar. “Among other advances, improving how CMS pays for drugs and for physician visits will help deliver on two HHS priorities: bringing down the cost of prescription drugs and creating a value-based healthcare system that empowers patients and providers.” “Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” said [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Are you prepared for the ICD-10 deadline?

ICD-10 is coming October 1st. Are you ready? By Julie Henry | September 11, 2015 The October 1 deadline for converting from ICD-9 to ICD-10 is fast approaching. As of October 1, ICD-9 codes will no longer be accepted. “At the end of the day, claims for services delivered on or after Oct. 1, must be coded using ICD-10 codes in order for the provider or organization to be paid,” says Pam Jodock, senior director of Health Business Solutions at Healthcare Information & Management Systems Society (HIMSS). “There is no grace period.” So are hospitals and other healthcare providers prepared for the switch? Robin Settle, partner at global management consulting firm Kurt Salmon, says that most, if not all hospitals and large physician groups are ready for ICD-10 and have been ready for well over a year. “Most have made the transition to EHRs to take advantage of the meaningful use incentives and to avoid meaningful use penalties,” she says. “ICD-10 compliant versions of software have been implemented as part of routine maintenance. Many hospitals also provided some ICD-10 training to their employed and community physicians.” Jodock says indications are that the majority of providers will be ready for the conversion on Oct. 1. “However, we do anticipate there will be small pockets of providers – primarily solo or small group practitioners – who may not be fully prepared,” she says. Is your organization prepared for the switch? Dr. Reid Conant, a board-certified emergency physician and CMIO at Tri-City Emergency Medical Group in Oceanside, CA, says he feels like his practice is prepared, but they are not taking the transition lightly. “We have prepared on both an educational level as well as a [...]

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