Request a Quote


Our Services


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.

­

Will the ICD-10 transition continue smoothly once CMS demands more specificity?

The Firm Services can help your office comply to ICD-10 February 22, 2016 | Carl Natale, Editor, ICD10Watch It's only a guess, but the ICD-10 transition doesn't look like it is taking down the U.S. healthcare system. So far, there are reports of minimal productivity drops and denial rate increases. But some reimbursement delays are being reported. It's not a perfect environment, but it doesn't appear to be a toxic one either. There's an argument to be made that close enough now counts in horseshoes, hand grenades and ICD-10 coding for Medicare. Since the Centers for Medicare and Medicaid Services (CMS) accepts codes from the correct ICD-10 family, some healthcare payers have followed suit. Reports suggest that as many as 25 percent of codes include the term unspecificied -- and that could be keeping denial rates in check. What's more, it's reducing pressure on healthcare providers to document a high degree of specificity. And they may be skipping some secondary diagnoses that don't affect reimbursement, according to Katherine Rushlau. Which would help physicians and medical coders keep records moving. There's a way to keep productivity up. (Or prevent it from sinking.) But is this going to work after Oct. 1, 2016? That's when CMS plans to require ICD-10 specificity. We don't know when private healthcare payers will want providers to get more specific. That's why Amy Sullivan, vice president of revenue cycle sales at PatientKeeper, is worried about more vigorous complaining and animosity when the specificity deadline approaches. The only way seen to prevent worse reimbursement problems is to improve clinical documentation that supports ICD-10 specificity and other healthcare payer initiatives that are coming. Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? [...]

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 [...]

How is ICD-10 affecting claim denials?

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES ICD 10 WATCH CARL NATALE JAN 27, 2016 - 06:00 AM There are some mixed messages on how much claim denials have risen since Oct. 1. Some healthcare providers are reporting a few ICD-10 denials but not enough to worry about. On the other hand, a healthcare consultant found out that a California HMO was denying medical claims on a massive scale. And NCDs and LCDs have needed tweaks to prevent mistaken denials. If this isn't a major national problem, it certainly can be a major problem for individual medical practices. So it needs to be fixed. First, measure ICD-10 claim denials and monitor revenue-based metrics. It is important to understand where the problems are occurring. Then medical practices can start fixing the problems that create denials. Second, figure out if the right ICD-10 codes are being used. There is lots of room for error so make sure the medical claims are coded correctly and clinical documentation supports the diagnoses. Keep investing in coding training. Third, keep calling the healthcare payers until they answer questions. Do not let any denial go because it's too much work. Best advice: Prevent denials Chris Nerney at Revenue Cycle Insights identifies three things that can help healthcare providers prevent claims denials: Registration processes: Denial problems can start before the first ICD-10 code is recorded. Medicaid: Which comprises 13 percent of all denials. Start by checking eligibility, medical necessity and pre-authorization. High-impact specialties: Specialties contribute heavily to major amounts of claim denials. (Repeat the advice in the first two tips). In a way, the macro claim denial statistics don't matter as much as the individual anecdotes. Those stories are [...]

Cigna temporarily banned from new Medicare plans

USA Today Nathan Bomey January 23, 2016 U.S. regulators have temporarily banned health insurer Cigna from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings. The insurer disclosed late Thursday in a public filing that the U.S. Centers for Medicare and Medicaid Services (CMS), had suspended the company from enrolling new customers or marketing plans for Cigna Medicare Advantage and Standalone Prescription Drug Plan Contracts. In an enforcement letter, CMS accused Cigna of "widespread and systemic failures," including the denial of health care coverage and prescription drugs to patients who should have received them. The actions "create a serious threat to enrollee health and safety," said CMS, which is requiring Cigna to appoint an independent monitor to audit its handling of the matter. The sanctions, which took effect at the end of the day Thursday, do not affect patients who are already enrolled. CMS said could not provide an estimate for how many patients were affected. Cigna had market share of 3% in Medicare Advantage plans in 2015, representing about 502,000 patients, according to the Kaiser Family Foundation. “As a company committed to delivering quality products and services, we focus on putting customers first. The findings in the audit are unacceptable and will be addressed in full partnership with CMS,” said Herb Fritch, president of Cigna-HealthSpring, in a statement. “We have internal quality review processes in place that identified some of the areas in advance of the audit findings and we have already started working to remedy them. In other instances, we will implement the changes as quickly as possible to emerge a stronger organization further dedicated to those we serve.” Cigna shares fell 1.2% to $138.52 as of [...]

Keeping up with ICD-10 education

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE ABYSS December 18, 2015 By Avery Hurt Many providers and coders are just getting into the ICD-10 groove, but staying there requires a little bit of ongoing training. For coders this means keeping up their certification. What many coders might not be aware of, however, is that time is running out. Most coders must complete a proficiency test or complete certain continuing education credits by Dec. 31, 2015. Otherwise they will lose their credentialing. Providers need to do a little continuing education as well if they want to stay on top of ICD-10. "Every now and then you need to look to make sure you are using the most specific code," suggested Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians. You don't want to fall into a rut of using the same codes when better ones are available. CMS is going easy on non-specific codes for the first 12 months of ICD-10, but next October will come before you know it. And private payers are expected to start tightening up sooner than that. At the moment, very few claims are being denied on the basis of diagnosis codes, but some experts have started to see a slight uptick in these denials. If you're not already using the most appropriate codes available, make sure you start soon, even if that means an ICD-10 refresher course. Hays said she didn't expect to see much in the way of significant policy changes from payers, but the codes themselves will be adjusted and refined on an ongoing basis. CMS will publish yearly updates to the ICD-10 codes—the flexibility to change as medical science [...]

End Of Medicare Bonuses Will Cut Pay To Primary Care Doctors

HEALTH INC. November 28, 2015-7:03 AM ET : Michelle Andrews Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all. The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 report by the Medicare Payment Advisory Commission. Although that may sound like a small adjustment, it can be important to a primary care practice, says Dr. Wanda Filer, president of the American Academy of Family Physicians. "It's not so much about the salary as it's about the practice expense," she explains. "Family medicine runs on very small margins, and sometimes on negative margins if they're paying for electronic health records, for example. Every few thousand makes a difference." Doctors in family medicine, internal medicine and geriatrics are eligible for the bonuses, as are nurse practitioners and physician assistants. Medicare generally pays lower fees for primary care visits to evaluate and coordinate patients' care than for procedures that specialists perform. The difference is reflected in physician salaries. Half of primary care physicians made less than $241,000 in 2014, while for specialists the halfway mark [...]

Why are Incorrect Characters a Top ICD-10 Coding Challenge?

Rev Cycle Intelligence- By Jacqueline DiChiara on November 17, 2015 “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant." Lack of training for inpatient procedural coding may pose a significant challenge for the healthcare industry as 2015 comes to a close, said Teri Jorwic, ICD-10 Educator and Professor of Healthcare Informatics at the University of Illinois at Chicago, to RevCycleIntelligence.com in an exclusive interview last September. icd-10-cm coding characters Jorwic caught up once again with RevCycleIntelligence.com to assess what has been happening across the greater healthcare space in regard to procedural coding concerns over the past month and a half. “The two main things I’ve heard so far have to do with either linking and LCDs [Local Coverage Determination] or NCDs [National Coverage Determination], particularly having to do with the injury codes and the seven characters,” Jorwic states. Questions about whether or not the coverage is the same post-October 1, 2015 are common, says Jorwic, who confirms coverage policy changes are on the horizon. “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant,” she says. Physical therapists, for instance, may struggle to determine differences between “initial” and “sequela,” as they often deal with a subsequent portion of injury when a patient enters regular recovery. Another problem now popping up involves new guidelines for the often perplexing Excludes1 notes, says Jorwic. “There is a new guideline in ICD-10-CM – the diagnoses side that says if you have an Excludes1 note, you cannot code conditions that appear in that Excludes1 notation together,” says Jorwic. “So, the classic example would be, for example, a patient that [...]

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 [...]

Smooth Rollout For New ICD-10 Medical Codes, Insurers Say

FORBES/ Pharma & Healthcare OCT 13, 2015 @ 07:55 AM Bruce Japsen ,CONTRIBUTOR The launch of tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the billing process has seen few problems in the early days of its launch, large health insurers say. The news of a smooth rollout thus far comes from Humana HUM +0.52% (HUM) and UnitedHealth Group UNH -0.16% (UNH) despite reports that one in four doctor practices weren’t ready for the October 1 transition to International Classification of Diseases, Tenth Revision, known as “ICD-10.” After two years of delays, medical care providers had to be ready at the beginning of this month for the conversion to 140,000 new codes that they will use in order to bill government and private insurers. The delays to help doctor practices get ready seem to have paid off. “The extra time has helped,” Robert Tennant, health information technology policy director at the Medical Group Management Association told more than 200 doctors at a panel featuring insurers at the group’s annual meeting in Nashville this week. Humana (HUM) said calls in the first week into the insurer that were specific to ICD-10 amounted to “only 0.03 % of all calls from providers regarding benefits, claim status, spanning date of service, and authorization.” Pediatrician Lanre Falusi examines an infant’s ear in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland. Photographer: Andrew Harrer/Bloomberg  Lanre Falusi “It’s been a pretty smooth transition so far,” Sid Hebert, who heads the ICD-10 implementation team at Humana (HUM) said. “We are about ten days into this and already have 50% of our claims coming in. Almost everyone who is [...]

ICD-10 Compliance a Struggle for Some Physician Practices

ICD-10 is here. Are you ready? By Kyle Murphy, PhD on October 12, 2015 October 1 has come and gone, and nearly two weeks in to ICD-10 compliance most of the healthcare industry is relatively mum on the transition to the newer clinical diagnostic and procedural code set. More than likely, healthcare organizations and professionals are busy enough adapting to ICD-10 and its more specific set of codes. That’s not to say some are not speaking out or in support of ICD-10 compliance. ICD-10 a struggle for some physician practices Two recent weekend reports in the Florida’s Crestview News Bulletin and Maine’s Bangor Daily News paint two very different pictures of ICD-10 compliance at the two-week mark. Apparently, some physician practices in the Florida panhandle are going through the motions in adapting to the federal mandate for ICD-10 compliance which began back on October 1. Brian Hughes reports that medical offices are encountering difficulties with the code set. “Large practices and medical companies, such as Peoples’ Home Health, usually have coders on staff. Their only job is to enter the numbers into billing records and insurance reimbursement forms,” he writes. “For smaller offices like Dr. Herf’s and Mir’s, the increased coding tasks take away staffers’ time with patients.” Betty Jordan, the manager of physician practice of Abdul Mir, MD, views ICD-10 as more of a hindrance than a help. “It requires so much extra work. If my doctor treated someone for rheumatoid arthritis, there’s hundreds of codes. It’s got to be specific,” she told the Crestview News Bulletin. “It is horrible for a primary care doctor,” she further revealed. “For a specialist, they deal with the same things over and over. For us [...]