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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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Payer Healthcare industry lambastes Trump administration’s short-term health plan proposal

Fierce Healthcare - by Mike Stankiewicz | Apr 24, 2018 1:31pm The health insurance and hospital sectors are nearly unanimous in their opposition to the Trump administration's proposal to expand short-term health plans, citing higher premiums as a major consequence if it moves forward. Such plans have historically been used during a lapse in coverage following a change in employment and limited to just a few months. But the Department of Health and Human Services (HHS) wants to expand short-term plan coverage for up to a year, a move viewed by many as an attempt to undermine the Affordable Care Act (ACA). The plans could skirt key ACA requirements, such as essential health benefits and pre-existing coverage protections. Administration officials contend the extension will give consumers more choice without raising premiums, but some of the industry's biggest players aren't buying it. The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go. In comments submitted to HHS (PDF), America's Health Insurance Plans (AHIP) said a year-long duration would move young, healthy people out of the exchanges, increasing premiums for older, sicker people who remain. "At the same time, we are concerned that this proposed rule will lead to more people being uninsured and underinsured, and to higher costs in the long run," Matt Eyles, incoming president and CEO of the trade association, said in a statement. Instead, AHIP recommended the administration extend the duration of short-term plans from 90 days to six [...]

The Definitive ICD-10 Guide to Holiday Movies

Santa's Healthy Heart! His new ICD-10 coded screening. Written by  Wendy Aiken, PMI-ACP | Monday, 14 December 2015 00:00 We all have one: a beloved holiday flick that inspires us to deck the halls, snuggle up, and press play. Whether you’re a die-hard fan of a Christmas classic, or you prefer the elven shenanigans of Will Ferrell, here’s one holiday treat everyone should enjoy: the coder’s complete ICD-10 list for holiday films. National Lampoon’s Christmas Vacation (1989) Clark Griswold, our favorite overly optimistic father, is no doubt a Christmas movie legend. Despite his high hopes for the perfect family Christmas, he gets more than his fair share of merry misfortune. Blame it on his questionable light-hanging practices, extreme sled-riding, and obsession with that Christmas bonus (for a pool, of course). T75.4XXA Electrocution, initial encounter V00.221A Fall from sled, initial encounter W16.0 Fall into swimming pool It’s a Wonderful Life (1946) After George Bailey, a failing businessman, crashes his car into a tree, he wishes he’d never been born. But a guardian angel shows him that the world would be a grim place if he didn’t exist, and George realizes he really does have a wonderful life. V47 Car occupant injured in collision with fixed or stationary object F33.4 Major depressive disorder, recurrent, in remission R42 Dizziness and giddiness A Christmas Story (1983) Poor Ralphie endures a suspenseful holiday season pining for an official Red Ryder, carbine-action, 200-shot range model BB gun. His friend, meanwhile, learns an ice-covered flagpole can leave you tongue-tied, and Ralphie’s father grieves the loss of his precious leg lamp. W34.118A Accidental malfunction of other gas, air, or spring-operated gun Q38.1 Ankyloglossia (tongue-tied) S82.301A Fracture of lower leg, initial encounter for [...]

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.