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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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Emergency cash a must for ICD-10

ICD-10 is coming October 1st. Are you ready? Extra funds can go a long way to relieving anticipated headaches of code change Healthcare providers may face disruptions in their payments even if they are on target to operate using ICD-10 codes on Oct. 1, 2014. Since providers will, and indeed need, to be able to pay rent and staff salaries if the transition does not flow as smoothly as testing has indicated, experts advise having up to several months' cash reserves or access to cash through a loan or line of credit to avoid potential headaches. "Just figure that with the transition to ICD-10 there will be delays in reimbursement," said April Arzate, vice president of client services at MediGain, a Dallas-based revenue cycle and healthcare analytics company. Although there will be a great deal of testing and preparation done by the vendors of practice management and electronic health record (EHR) systems by clearinghouses and payers, "we really won't know the true effect until they turn it on," Arzate added. Mitigate revenue disruption The recommendation that Arzate pointed to is to reserve at least enough money to cover medical supplies, payroll, rent, everything required to keep the practice operational for three to six months — just in case any payers experience disruptions in cash flow that delay payments. That's especially difficult for small practices. "You may not have to have it on hand," Arzate explained, "but you need to have the resources available." It's better to talk with the bank now before the funds are needed, added Clint Hughes, MediGain vice president of marketing. "The bank will be more open now than if you come to them desperate because you're two months behind," he said. Arzate suggested that they establish [...]

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

Medicare ICD-10 Questions? We have answers at The Firm Services July 6,2015 CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” “ICD 10 [...]

Supreme Court saves Obamacare

Physicians Credentialing Services By Ariane de Vogue and Jeremy Diamond, CNN Washington (CNN) Obamacare has survived -- again. In a 6-3 decision, the Supreme Court saved the controversial health care law that will define President Barack Obama's administration for generations to come. The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage. "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all," Obama said from the White House. "The Affordable Care Act is here to stay" In a moment of high drama, Chief Justice John Roberts sent a bolt of tension through the Court when he soberly announced that he would issue the majority opinion in the case. About two-thirds of the way through his reading, it became clear that he again would be responsible for rescuing Obamacare. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter." READ: John Roberts' big moment: Will he anger conservatives again? He was joined by Justice Anthony Kennedy -- who is often the Court's swing vote -- and the four liberal justices. Justice Antonin Scalia wrote [...]

HHS Inspector General Issues Physician Compensation Medicare Fraud Alert

Physicians Credentialing Doctors for Medicare HHS Inspector General Issues Physician Compensation Medicare Fraud Alert posted on: Wednesday, June 17, 2015 The Office of the Inspector General of the Department of Health and Human Services (“OIG”) issued a warning earlier this month to physicians. The OIG enforces healthcare laws including the Stark Law and Anti-Kickback statute. Federal law prohibits hospitals from offering anything of value in exchange for certain healthcare business. Physicians can be paid for their services but not for sending Medicare patients to hospitals. In recent years, there have been many prosecutions of hospitals for violating anti-kickback rules. Long gone are the days when a hospital would reward doctors bringing in patients with a cash bonus. Now, the “kickbacks” or bribes are more concealed. Compensation agreements between hospitals and doctors are always scrutinized carefully. On June 9th, the OIG issued a written fraud alert to warn hospitals and doctors of new schemes that they see as problematic. This is only the fourth time in five years that the OIG issued a written fraud alert. According to the Department of Health and Human Services, doctors who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for services actually provided. Even if a compensation package is otherwise legal, it can still violate the law if just one of its purposes is designed to compensate the physician for bringing in Medicaid or Medicare patients. The written guidance specifically addresses “medical directorship” arrangements.  The OIG believes some doctors are being given titles and extra pay simply because they bring in more patients. To avoid violating the law, a doctor offered a directorship must actually perform the duties of [...]

CMS Releases Medicare Cost Data on Physicians. Now What?

Credentialing, Revalidation Services professionals at The Firm Services Jacqueline Fellows, for HealthLeaders Media , June 4, 2015 Data limitations don't give an accurate picture of what Medicare reimbursement really means for physicians. But patients are increasingly aware of healthcare costs, and physicians should not shy away from a conversation. The report released this week by the Centers for Medicare and Medicaid Services detailing that over 950,000 providers were paid $90 billion for medical services they provided to Medicare beneficiaries in 2013 has spawned sensational headlines about Medicare's millionaire doctors. The headlines aren't wrong, but it's a small group of physicians that are garnering the attention of many. To prevent an inaccurate narrative, doctors may need to prepare for patients' questions. This is the second time CMS has released physician-specific data for Medicare payments in an effort be more transparent. In a prepared statement, American Medical Association President Robert Wah, MD, commended CMS for its effort, but criticized the agency for giving so little context to what the data means for patients. "Specifically, the data released today do not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions … [or] enough context to prevent the types of inaccuracies, misinterpretations, and false assertions that occurred the last time the administration released Medicare Part B claims data." It's true that the data has many limitations. For one, there is no information that gauges quality. It also shows information only on Medicare services. Depending on the payer mix of a physician office, Medicare beneficiaries could be a minority or majority. Geographic variation in payment amounts isn't accounted for. Despite the criticism and the limits of the data, [...]

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.