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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bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.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 [...]

If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

NPR- September 22, 20173:19 PM ET -Danielle Kurtzleben John McCain on Friday imperiled Republicans' latest Affordable Care Act repeal and replace effort when he said he "cannot in good conscience" support the so-called Graham-Cassidy bill. But McCain did also say he could at some point support the substance of his fellow Republicans' proposal. "I would consider supporting legislation similar to that offered by my friends Sens. [Lindsey] Graham and [Bill] Cassidy were it the product of extensive hearings, debate and amendment," McCain said. "But that has not been the case." That's notable because for the first time since Trump became president, there actually seemed to be some real ideological unity around a repeal-and-replace effort from Republicans. Graham-Cassidy Health Bill Would Shift Funds From States That Expanded Medicaid If it is revived — and this effort isn't quite dead yet, because other GOP holdouts haven't stated their unequivocal opposition publicly — the Graham-Cassidy bill very well may be the foundation of how the health care system is reshaped. What would it mean for where you live? We take a look A big selling point of Graham-Cassidy, according to its proponents, is flexibility for states. In place of the federal dollars that fund Obamacare's subsidies and Medicaid expansion, Graham-Cassidy, which under the latest GOP proposal would be law in 2020, would give states block grants. Those are big chunks of money given directly to states, which would have broad discretion in how to spend them. But what's important is that those block grants would be less money than the total money that states are getting for Obamacare right now. Graham-Cassidy would eliminate the premiums that help people pay for their health insurance and the payments helping insurance companies [...]

By |September 23rd, 2017|Blog, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Optometrist, Physician Credentialing|Comments Off on If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

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 [...]

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 [...]

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 Releases FAQs To Clarify Plan To Ease ICD-10 Transition

ICD-10 is coming October 1st. Are you ready? Wednesday, July 29, 2015 On Monday, CMS released answers to frequently asked questions to help clarify recently announced measures that aim to provide physicians with some flexibility as they transition to the new ICD-10 code sets, EHR Intelligence reports. Background U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.  On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians' transition. Among other things, CMS said it would: Appoint an ICD-10 ombudsman to help oversee the transition; Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes; Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and Provide a range of online resources -- including Web conferences and training documents -- to aid providers in the transition. FAQ Details CMS posted a list of 13 FAQs to clarify several aspects of the measures. For example, the agency noted that: The ICD-10 ombudsman will be in place by Oct. 1; The measures do not signify an ICD-10 delay; Submitters whose claims are denied will be notified with an explanation of the rejection; Submitters should follow existing processes for correcting and resubmitting rejected claims (Goedert, Health Data Management, 7/28); The measures only apply to Medicare fee-for-service claims; The guidance does not apply to Medicaid claims, but each state will be "required to process submitted claims that include ICD-10 codes for services furnished [...]

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