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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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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 [...]

Trump urges insurers to work together to ‘save Americans from Obamacare’

Will Obamacare survive? Washington Post - By Carolyn Y. Johnson and Juliet Eilperin February 27 at 12:19 PM  President Trump met with major health insurers Monday morning, in the midst of political divisions over how to dismantle and replace President Obama's signature health-care law, the Affordable Care Act, and intensifying public pressure to preserve the policy. The meeting included leaders from Blue Cross Blue Shield, Cigna, Humana, UnitedHealth Group, Aetna, Anthem, Kaiser Permanente and the industry lobbying group, America's Health Insurance Plans. "We must work together to save Americans from Obamacare," Trump said in public remarks before the closed-door meeting. He criticized the Affordable Care Act, commonly known as Obamacare, for creating minimal health coverage requirements that restricted the types of plans insurers could sell. "Obamacare forced providers to limit the plan options they offered to patients and caused them to drive prices way up," Trump said. "Now a third of U.S. counties are down to one insurer, and the insurers are fleeing. You people know that better than anybody." Over the past month, more insurers have warned that they could pull out of the Affordable Care Act’s health-care exchanges where individuals can buy government-subsidized insurance. Aetna chief executive Mark Bertolini has described the exchanges as being in a "death spiral." Humana — which insures about 150,000 people on the exchanges this year — announced in mid-February it would exit the exchanges in 2018. In an earnings call, Molina Healthcare disclosed that its exchange business lost $110 million in 2016 and said it would evaluate its participation for next year on a state-by-state basis. A Molina spokeswoman said the company, which insures 1 million members through the exchanges, was not invited to the meeting. Trump gave [...]

Showing panic over Obamacare repeal, GOP senators release replacement plan that (almost) makes sense

Will Obamacare survive? LA Times - Michael Hiltzik - January 24,2017 2;25pm If you’re following the health insurance debate—and since the coverage of more than 20 million Americans is under threat from the Trump White House and the Republican congressional majority, you should be—you’re going to be hearing a lot in the coming weeks about Cassidy-Collins. That’s an Obamacare replacement plan just introduced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine). Dubbed the Patient Freedom Act, It’s the first such proposal that indicates that the GOP is becoming increasingly panicked about the political price of repealing the Affordable Care Act outright, and increasingly desperate to reassure voters that the provisions of Obamacare they actually value can be retained without a break. These include Obamacare’s protection of coverage for pre-existing conditions, its ban on lifetime and annual limits for benefits, and coverage of certain preventive services without co-pays. It also keeps coverage of mental health services and guarantees black-lung benefits for coal miners. The federal exchange, healthcare.gov, will continue to operate. Dependents still will be permitted to stay on their parents’ employer-sponsored plans until age 26. The measure kills the employer mandate and individual mandate, though it substitutes a “continuous coverage” system for the latter, which we’ll explain in a bit. The other [Republican] bills have said, Let’s just get rid of Obamacare. This one seems to be offering options. — Karen Pollitz, Kaiser Family Foundation The goal of Cassidy-Collins is to shift the the decision of whether to keep Obamacare, dump it entirely, or come up with an alternative system to the states. (A three-page section-by-section summary is here.) “When you speak to Americans,” Cassidy said Monday on the Senate floor, “they [...]

How Large Employer Health Plans Could Be Affected By Obamacare Overhaul

Will Obamacare survive? Kaiser Health News- January 19, 2017 5:00 AM ET MICHELLE ANDREWS If you think that you wouldn't be touched by a Republican overhaul of Obamacare because you get health insurance through your job at a big company, think again. Several of the law's provisions apply to plans offered by large employers, too (with some exceptions for plans that were in place before the law passed in March 2010). It's not yet clear how President-elect Donald Trump and congressional Republicans plan to revamp the federal health law, known as the Affordable Care Act or Obamacare. They have not agreed on a plan, and they do not have enough votes in the Senate to fully repeal the current statute. So they are planning to use a budgeting rule to disassemble part of the law, which will limit what they can change. But they also may seek revisions in important regulations and guidance that have determined how the law is implemented. Nonetheless, as tensions grow in Washington over the future of the health law, it is important to understand some of its effects on large-group plans. No copays for preventive services The health insurance offered by big companies is typically pretty comprehensive, the better to attract and keep good employees. But Obamacare broadened some coverage requirements. Under the law, insurers and employers have to cover many preventive services without charging people anything for them. The services that are required with no out-of-pocket payments include dozens of screenings and tests, including mammograms and colonoscopies that are recommended by the U.S. Preventive Services Task Force; routine immunizations endorsed by the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices; and a range of [...]

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 [...]

ObamaCare and Big Insurance

The Justice Department tries to block the mergers that Obama’s health law intended. Wall Street Journal- July 24, 2016 6:15 p.m. ET Politicians tend to be most enraged by the problems they cause, and the liberal fury against insurance mergers is a classic of the genre. ObamaCare was designed to create government-directed oligopolies, but now its authors claim to be alarmed by less competition. Last week federal and 11 state antitrust regulators filed a double lawsuit to block the pending $54 billion insurance tie-up between Anthem and Cigna and the $37 billion acquisition of Humana by Aetna. The mergers would reduce the national commercial insurers to three from five, and Attorney General Loretta Lynch says the government won’t cede such “tremendous power” over health care to a more concentrated industry. Has she checked with the White House? The logic of ObamaCare is that larger and more integrated conglomerates are superior to a market with many insurers, doctors and hospitals vying for consumer business. The law promotes corporatism on the theory that larger systems are more efficient, but also because giants are easier to control politically and will standardize care as ordered. The new regulations and mandates since the law passed in 2010 are designed to encourage consolidation, from accountable care organizations to new reimbursement methods and much else. The rise of huge health systems, salaried physicians and mega-insurers is precisely what Peter Orszag and Jonathan Gruber wanted. But now the trust busters are fretting that these giants will have less incentive to innovate to reduce costs and improve quality, and patients will have fewer choices. Well, yes—as critics predicted. “Competitive insurance markets are essential to providing Americans the affordable and high-quality health-care they deserve,” Ms. [...]

ICD-10 conversion had minimal impact on hospitals’ denial rates, report finds

Written by Kelly Gooch | June 29, 2016 After three delays and much industry opposition, the United States' healthcare industry transitioned Oct. 1, 2015, to ICD-10, increasing the number of diagnostic codes from 13,000 to 68,000. The transition was expected to have far-reaching, disruptive consequences, such as delays in billing and coding, the potential for increased payer denials and accounts receivable and the possibility of decreased cash collections. However, new data shows the conversion minimally impacted cash collections, initial denial rates and days in accounts receivable, according to a report from public accounting, consulting and technology firm Crowe Horwath. This data came from Crowe Revenue Cycle Analytics, a benchmarking solution that compiles and organizes a daily feed of transactional-level data from the patient accounting systems of nearly 600 hospitals. These reports outline findings based on an assessment of key performance indicators related to billing and coding, accounts receivable and denials. The Crowe report details the analysis of data examined through March 31. Here are four findings from the report. 1. On average, there was minimal impact on cash collections, initial denial rates and days in accounts receivable due to the ICD-10 conversion; however, there were delays in inpatient billing and coding, Crowe said. This resulted in a 10.1 percent increase in inpatient discharge and not final billed days from October through December 2015, compared to the same period in 2014. 2. Crowe observed a temporary increase in denial claim adjustment reason code 11, indicating the diagnosis is inconsistent with the procedure, for a small number of hospitals. As a percentage of total gross patient services revenue, this denial reason code spiked from October through December 2015. Brian Sanderson, managing principal of Crowe healthcare services, said [...]

Federal judge strikes down Obamacare payments

Richard Wolf, Gregory Korte and Jayne O'Donnell, USA TODAY 6:02 p.m. EDT May 12, 2016 WASHINGTON — Republicans won the first round Thursday in a separation of powers battle against President Obama that once again focuses on his most prized achievement: Obamacare. Federal district Judge Rosemary Collyer, a Republican appointee, ruled that the law did not provide for the funds insurers need to make health insurance policies under the program affordable. While the law provides for tax credits, she said, it does not authorize an appropriation for slashing deductibles and copayments. Without those reductions from insurers, many consumers could not afford to buy insurance. "Congress authorized reduced cost-sharing but did not appropriate monies for it,," Collyer said in her 38-page ruling. "Congress is the only source for such an appropriation, and no public money can be spent without one." Collyer blocked her own decision from taking effect while awaiting a likely appeal from the administration. Cost-sharing subsidies reduce consumers' insurance payments — an important feature of the Affordable Care Act, because deductibles are rising. Under the law, subsidies are available to people who earn between 100% and 400% of the federal poverty level, with extra assistance available for those up to 250%. For a family of four, that’s about $24,000 to $61,000. The Commonwealth Fund estimated up to 7 million people might have plans with cost-sharing reductions this year. The ruling does not represent as big a threat to the health care law as two previous conservative challenges swatted down by the Supreme Court in 2012 and 2015. The first would have gutted the law; the second would have eliminated tax credits in many states. “It’s a setback, and it’s a distraction … but a [...]

ICD-10’s Impact to the Worker’s Compensation Industry

The Firm Services has the latest information regarding ICD-10 and its implementation. Written by Sherry Wilson and Tina Greene | Monday, 28 March 2016 04:00 A general assumption had been that states would be aligning their worker’s compensation regulations with the rest of those of the healthcare industry in order to adopt the ICD-10 regulations. As of Oct. 1, 2015, there were only 21 states that had aligned with the Centers for Medicare & Medicaid Services (CMS) ICD-10 requirement, according to the WEDI Property and Casualty ICD-10 State Readiness Resource Center and the International Association of Industrial Accident Boards and Commissions (IAIABC) ICD-10 State Survey results. The states that had aligned with the CMS ICD-10 regulations included Alabama, California, Delaware, Florida, Georgia, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, North Carolina, New Hampshire, Nevada, New York, Ohio, Oregon, Pennsylvania, South Dakota, Texas, Washington, and the U.S. Department of Labor. So, what has been the impact to stakeholders post-ICD-10 in the other 29 states? The following is a summary profile of the ICD-10 status of the other 29 states and reported stakeholder impact: Three states with pending ICD-10 regulations post-Oct. 1, 2015 included Alaska, Wyoming, and Tennessee. The following is the reported ICD-10 post-implementation impact: Wyoming is allowing providers to submit ICD-9 and ICD-10 for one year as a transition plan and will adopt ICD-10 when their rulemaking becomes effective. Alaska and Tennessee have encouraged stakeholders to move forward with ICD-10 while their rulemaking process remains pending. Payer Impact: Payers that do business in these states are required to support ICD-10 and ICD-9 codes during the regulatory transition period. Provider Impact: Providers that are submitting ICD-10 claims have reported no impact to their revenue cycle [...]

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 ? [...]