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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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Obamacare Hits a Pothole

Let the Experts at The Firm Services assist your practice. NY Times - Opinion Page- Paul Krugman OCT. 28, 2016 For advocates of health reform, the story of the Affordable Care Act, a.k.a. Obamacare, has been a wild roller-coaster ride. First there was the legislative drama, with reform seemingly on the edge of collapse right up to the moment of passage. Then there was the initial mess with the website — followed by incredibly good news on enrollment and costs. Now reform has hit a pothole: After several years of coming in far below predictions, premiums on covered plans have shot up by more than 20 percent. So how bad is the picture? The people who have been claiming all along that reform couldn’t work, and have been wrong every step of the way, are, of course, claiming vindication. But they’re wrong again. The bad news is real. But so are reform’s accomplishments, which won’t go away even if nothing is done to fix the problems now appearing. And technically, if not politically, those problems are quite easy to fix. Health reform had two big goals: to cover the uninsured and to rein in the overall growth of health care costs — to “bend the curve,” in the jargon of health policy wonks. Sure enough, the fraction of Americans without health insurance has declined to its lowest level in history, while health cost growth has plunged: Since Obamacare passed Congress, private insurance costs have risen less than half as fast as they did in the previous decade, and Medicare costs have risen less than a fifth as fast. But if health costs are looking good, what’s with the spike in premiums? It only applies [...]

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 [...]

CMS will reimburse ICD-10 mistakes for one year after transition deadline

ICD-10 is coming October 1st. Are you ready? By Virgil Dickson  | July 6, 2015 Modern Healthcare –“The leader in healthcare business news, research & data” The CMS has made a concession in the transition from ICD-9 to ICD-10. For one year past the Oct. 1, 2015 deadline, the CMS will reimburse for wrongly coded claims as long as that erroneous code is in the same broad family as the right one. There had been concerns among providers that they wouldn't be paid if they made minor mistakes trying to implement the new complex coding system. That may be why the American Medical Association had a change of heart recently in getting providers on board. The association, a longtime critic of the Obama administration's mandate to move from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, has announced its teaming up with the CMS to make the transition easier for providers. The two parties plan to conduct a nationwide outreach effort to educate providers through webinars, on-site training, educational articles and calls to help physicians and other providers get up to speed before the Oct. 1 deadline. Just two months ago, the AMA voiced support for a bill crafted by Republican Texas Rep. Ted Poe that would prohibit HHS from replacing ICD-9 with ICD-10. For years, the organization has questioned the need for the transition and noted that complying with the new codes could cost providers three times more than previous estimates. Texas' state medical association, the largest in the country, has vigorously fought the implementation, arguing that doctors have been subject to a recent onslaught of costly government edicts that threaten to drive more physicians out of business. An AMA spokesperson said the change of [...]

How Identity Theft Sticks You With Hospital Bills

Medical Identity Theft Thieves use stolen personal data to get treatment, drugs, medical equipment By WSJ- STEPHANIE ARMOUR- Updated Aug. 7, 2015 7:08 p.m. ET Kathleen Meiners was puzzled when a note arrived last year thanking her son Bill for visiting Centerpoint Medical Center in Independence, Mo. Soon, bills arrived from the hospital for a leg-injury treatment. But her son had never been there. Someone had stolen Bill Meiners’s Social Security and medical-identification numbers, using them to get care in his name. If he had been injured, she would have known: Mr. Meiners, a 39-year-old convenience-store worker with Down syndrome, lives with his parents in south Kansas City. To clear things up, Mrs. Meiners, who turns 74 on Saturday, took him to the hospital to show he was fine. It didn’t work: She says she spent months fighting collection notices and trying to fix his medical records. In a twist on identity theft, crooks are using personal data stolen from millions of Americans to get health care, prescriptions and medical equipment. Victims sometimes only find out when they get a bill or a call from a debt collector. They can wind up with the thief’s health data folded into their own medical charts. A patient’s record may show she has diabetes when she doesn’t, say, or list a blood type that isn’t hers—errors that can lead to dangerous diagnoses or treatments. Adding insult to injury, a victim often can’t fully examine his own records because the thief’s health data, now folded into his, are protected by medical- privacy laws. And hospitals sometimes continue to hound victims for payments they didn’t incur. Fueling medical identity theft is the surge in electronic medical records and data breaches [...]

Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors

Firm Services provides Physician Credentialing and Revalidation Thousands of doctors who bill Medicare used questionable addresses, GAO report finds By CHRISTOPHER WEAVER :Updated July 21, 2015 8:09 p.m. ET Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program. Medicare records listed doctors and other providers as practicing at invalid addresses, such as commercial mailbox stores, construction sites and, in one case, a fast-food restaurant, according to a report by the Government Accountability Office that examined data through March 2013. Over the past five years, the federal Centers for Medicare and Medicaid Services, which runs Medicare, has been revamping its enrollment system and verifying provider information, such as addresses and licensure. The overhaul is partly due to requirements of the 2010 Affordable Care Act. The CMS said Tuesday that as a result of its enhanced screening efforts, it has kicked more than 34,000 providers out of the program since February 2011. The GAO says that some screening problems persist, however, among the 1.8 million providers enrolled to bill Medicare from nearly a million addresses. The report estimated that about 23,400 addresses might be invalid. The 2.3% of provider addresses the GAO estimated might be invalid could be the results of data-entry errors, according to written responses to the GAO by Jim Esquea, the assistant secretary for legislation for the federal Department of Health and Human Services. CMS said some provider locations flagged in the GAO report didn’t turn out to be fraudulent. For instance, the provider who listed the fast-food location had a valid medical office elsewhere and [...]

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 [...]

Big change coming soon for high income Medicare beneficiaries

Buried in the new “Doc Fix” law are provisions that will adversely affect some folks on Medicare May 13, 2015 @ 3:42 pm - By Katy Votava http://www.investmentnews.com/article/20150513/FREE/150519958/big-change-coming-soon-for-high-income-medicare-beneficiaries Physicians Credentialing Doctors for Medicare Higher-income Medicare beneficiaries have been paying more for their Medicare Parts B and D coverage for several years in the form of income-related monthly adjustment amounts. As a result of a new bill that sailed through Congress with bipartisan support and was signed into law by President Barack Obama in mid-April, costs for upper-income Medicare beneficiaries will increase soon. The legislation is officially called the Medicare Access and CHIP Reauthorization Act of 2015, otherwise known as the “Doc Fix” law. The major focus of this law is to permanently repair the long-broken method of paying doctors under Medicare, secure permanent funding for low-income Medicare recipients and ensure that children will be able to get access to health coverage. Buried in the law are other provisions that will adversely affect some folks on Medicare. One of those provisions is that the scale for setting the Medicare B and D IRMAAs will change dramatically in the near future, resulting in more high-income individuals paying sizable IRMAA amounts. This recent law changes that scale in the near future resulting in more beneficiaries paying the top IRMAA levels sooner than is currently the case. Keep in mind that the modified adjusted gross income determination by the Social Security Administration in any year is drawn from the tax return two years prior. Case in point, while the law stipulates that new MAGI tier definitions go into effect 2018, the 2016 tax return will be used to set those 2018 IRMAA payments. There have been dramatic changes [...]

By |May 14th, 2015|Commercial Insurance, Consulting, Healthcare Changes, Medicaid, Medical Credentialing, Medical Insurance, Medicare, Press|Comments Off on Big change coming soon for high income Medicare beneficiaries

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 [...]