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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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CVS-AETNA MERGER GETS NY APPROVAL, TO BE FINALIZED THIS WEEK

Health Leaders by BY JOHN COMMINS | NOVEMBER 26, 2018 The approval from New York comes with a boatload of conditions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance enrollment. KEY TAKEAWAYS CVS files notice with SEC stating that the merger will be finalized "on or about Nov. 28." Approval comes two weeks after California gave stipulation-laden approval. Feds approved the deal last month. The $69 billion deal has the potential to fundamentally change healthcare delivery. The megamerger of CVS Health Corp. and Aetna Inc. got the go-ahead Monday from New York state officials, clearing its last hurdle in a $69 billion deal that is expected to be finalized on Wednesday.The approval of New York's Department of Financial Services comes with a boatload of conditions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance education and enrollment and other consumer health protections, DFS said in a media release. "DFS listened to the concerns of the public and has obtained significant commitments from CVS and Aetna to address those concerns, ensuring that the companies hold to their promises of reduced costs and improved health care for New Yorkers, not pass on the costs of this acquisition to New Yorkers, enhance data privacy, and not act in an anti-competitive manner going forward," Financial Services Superintendent Maria T. Vullo said. "DFS will use its full regulatory authority to ensure that the companies adhere to these robust commitments and that both CVS and Aetna are held accountable for promises made to New Yorkers," she said. The approval comes two weeks after the deal cleared another [...]

Humana, Kaiser Permanente top customer satisfaction index

HEALTHCAREDIVE- AUTHOR -Les Masterson- Nov. 13, 2018 Dive Brief: The health insurance industry is the least satisfying category in any sector, according to the latest report from the American Customer Satisfaction Index (ACSI). ASCI found that the health insurance industry's scores were flat after two years of gain. Overall, health insurers averaged a score of 73 out of a possible 100, which is the same as a year ago. Humana and Kaiser Permanente topped the survey with scores of 78. Both companies dropped by one point in 2018. Dive Insight: ASCI surveys people on the finance and insurance sector, including banks, credit unions, property and casualty insurance, life insurance, internet investment services, financial advisors and health insurance. For this year's survey, the group interviewed 25,555 customers between Oct. 2, 2017, and Sept. 26. Overall, customer satisfaction with the finance and insurance sector increased by 1.4% and reached its highest level in 24 years (78.3). "Health insurance is complicated and controversial, making it by far the most problematic and least satisfying category in the sector," David VanAmburg, managing director at the ACSI, said in a statement. Kaiser Permanente ranked No. 1 for fastest to process claims and the best prescription coverage. Humana was the leader in offering access to primary and specialty care. An interesting twist is that two companies in the middle of mergers both improved scores from 2017. Aetna increased from 74 to 75 and Cigna jumped from 66 to 73. Aetna ranked No. 1 for its mobile app. Cigna, which had the lowest marks a year ago, offered the lowest complaint rate in the industry, ACSI said. Overall, health insurance has improved access to primary care doctors (80). Access to specialty care remained at [...]

CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients

cms.gov- November 01,2018 CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients Changes to the Medicare Physician Fee Schedule and Quality Payment Program will shift clinicians’ time from completing unnecessary paperwork to providing innovative, high-quality patient care. Today, the Centers for Medicare & Medicaid Services (CMS) finalized bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule released today also modernizes Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services, no matter where they live. It makes changes to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes. Today’s rule also updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade. “The historic reforms CMS finalized today move us closer to a healthcare system that delivers better care for Americans at lower cost,” said Health and Human Services (HHS) Secretary Alex Azar. “Among other advances, improving how CMS pays for drugs and for physician visits will help deliver on two HHS priorities: bringing down the cost of prescription drugs and creating a value-based healthcare system that empowers patients and providers.” “Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” said [...]

Cigna revenue boosted by commercial growth, now eyes Medicare Advantage

HealthcareDive- AUTHOR -Les Masterson- PUBLISHED- Nov. 1, 2018 Dive Brief: Cigna announced Thursday its revenue increased by 9% to $11.5 billion in the third quarter and credited growth in its global healthcare and supplemental benefits segments. The Bloomfield, Connecticut-based payer's adjusted income from operations increased to $945 million from $716 million a year ago. The payer finished the quarter with nearly 16.3 million medical customers, mostly commercial members. Unlike other payers that have focused more on government health plans, Cigna has only 485,000 members in government plans but is looking at Medicare Advantage as a future growth opportunity. Dive Insight: Cigna continues to grow organically in commercial plans, differing from other payers that are expanding government plans like as Medicare Advantage and Medicaid in the quarter. One reason for Cigna's focus on commercial plans is that CMS barred the payer from the MA market for more than a year. Cigna returned to the the market last year, but missed out on some of the growth other payers have enjoyed in MA. Despite Cigna being behind other payers in MA, the company's CEO David Cordani said the payer still views the plans as an "attractive growth opportunity." Cordani added that Cigna is adding a new market in MA next year and expects a larger expansion in the area in 2020. Cigna said its third quarter revenue increase came from commercial customer growth, expanded specialty relationships and premium increases. Premiums increased from $8.1 million in Q3 2017 to almost $9 million in Q3 2018. For the year, Cigna has picked up about $3 million more in premium revenue compared to 2017. The payer finished the quarter with $27 million in premium revenue for 2018. Cigna has seen membership growth over [...]

Come out and hear our owner Tia Aspra speak at 11th edition of Larry Laurent’s Chiropractic Law Seminar

Come out and hear our owner Tia Aspra speak at 11th edition of Larry Laurent’s Chiropractic Law Seminar series on Saturday, September 8, 2018. This fall’s event will be held in Austin, at the Granduca Hotel – 320 South Capital of Texas Hwy, Bldg B, Austin, Texas, 78746 from 8:00 a.m. to approximately 5:30 p.m. Ms. Tia Aspra of Financial Investigation & Reimbursement Management and Ms. Kathy Jones of NACA - Texas, will be providing tips on risk management, coding, credentialing, documentation and office compliance practices to ensure that your new practice complies with all state and federal laws, as well as our Board’s regulatory programs. This Chiropractic Law seminar has been approved for 8 hours of CE credit, including the 4 hours of Ethics, Documentation and Jurisprudence required by the Texas Board of Chiropractic Examiners. We have kept the cost low - $198.00 for doctors, $79.00 for staff accompanying a doctor and $98 for CA/staff attending without a doctor. You will have the opportunity to obtain thousands of dollars worth of free legal information, consulting services and information on office procedures for a very low registration fee. To register give Larry Laurent a call at (512) 996-8844 or send an email to (larry@larrylaurent.com) if you have any questions. We hope to see you in Austin on Saturday, September 8, 2018.

By |September 4th, 2018|Chiropractic, doctor, doctor Credentialing, Health Insurance, Healthcare Changes, Healthcare Professionals, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Multi-Specialty, Obamacare, Physician Credentialing, Specialties, Staff Training|Comments Off on Come out and hear our owner Tia Aspra speak at 11th edition of Larry Laurent’s Chiropractic Law Seminar

CMS Proposes Site-Neutral Payments, Drug Price Negotiation

HealthPayer Intelligence- Thomas Beaton- July 26,2018 A proposed rule from CMS aims to expand the use of site-neutral payments, and drug price negotiation at the federal level, to reduce Medicare costs. CMS has proposed a rule that would expand the use of site-neutral payments and improve the drug price negotiation process with manufacturers in order to reduce Medicare’s overall spending. The new rule would allow Medicare to reimburse providers with site-neutral payments for clinic visits, such as check-ups. CMS explained that clinic visits contribute significantly to preventable spending, because many providers charge varying rates for clinic visits. By using site-neutral payments, CMS expects to control spending and reduce clinic costs for beneficiaries. The new payments would lower the cost of clinic visits from $116 with a $23 beneficiary copay down to $46 and a copay of $9. “If finalized, this proposal is projected to save patients about $150 million in lower copayments for clinic visits provided at an off-campus hospital outpatient department,” the agency said in a press release. “CMS is also proposing to close a potential loophole through which providers are billing patients more for visits in hospital outpatient departments when they create new service lines.” By 2019, CMS also expects to reduce hospital outpatient spending by $760 million through the use of site-neutral payments within the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. CMS is adjusting provider payment rates within both programs to promote site neutrality between ASCs and hospital settings. The rule also contains a request for information (RFI) about how to improve the competitive acquisition program (CAP), so CMS can negotiate prescription drug prices with greater authority. CMS is seeking comments about how to innovate [...]

CMA News – Coding Corner : Modifier 59

California Medical Association News - Coding Corner: Modifier 59 -May 01, 2018 | Practice Management CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Modifier 59 Distinct procedural service is an “unbundling modifier.” When properly applied, it allows you to separately report—and to be reimbursed for—two or more procedures that normally would not be billed or paid independently during the same provider/patient encounter. For example, per CPT Assistant (Jan. 2018): Code 20680 [Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)] describes a unit of service that is typically reported only once, provided the original injury is located at only one anatomic site, regardless of the number of screws, plates, or rods inserted, or the number of incisions required for removal. The removal of a single implant system or construct, which may require multiple incisions (eg, intramedullary [IM] nail and several locking screws) is reported only once with code 20680. Reporting code 20680 more than once is appropriate only when the hardware removal is performed for another fracture(s) in a different anatomical site(s) unrelated to the first fracture (eg, ankle hardware and wrist hardware). In these circumstances, modifier 59, Distinct Procedural Service, would be appended to subsequent uses of the implant removal code. CPT® and CCI Conditions to Append Modifier 59 As outlined in the CPT® codebook, the general conditions under which you might append modifier 59 include situations where two or more CPT® codes, not normally reported together, are performed at a: Different session Different procedure or surgery [...]

Legal Compliance: One More Reason to Collect Patient Deductibles and Copays

WEBPT - By Tom Ambury - June 24, 2018 Collecting coinsurance, copays, and deductibles upfront is an important piece of the effort to accurately value the services we provide. And yet, we still hear about practices that routinely waive their patients’ deductibles and copays. Today, I’ll discuss another reason not to routinely waive deductibles and copays. In the past, I’ve written about collecting deductibles and copays when a patient presents with a federally funded insurance like Medicare. In cases involving the Department of Justice, the powers that be have stated very clearly that the practice of routinely waiving deductibles and copays can be a violation of the Federal Anti-Kickback Statute. But what about commercial insurances like BlueCross BlueShield, Aetna, and Cigna? That’s what I’ll chat about today. Why You Shouldn’t Waive Before I get into the compliance-related reasons to collect full payment for our services, let me say that to me, from a business standpoint—and with the knowledge that payments are continually being reduced as the cost of doing business keeps rising—it’s hard to imagine why a provider wouldn’t want to collect full payment for his or her services. Here’s an example I came up with to better explain my point: Let’s say you’re getting paid $75 per visit from a commercial insurance company, with $25 of that total coming from the patient’s copay and $50 from the insurance company. (These totals don’t necessarily reflect what’s happening in the real world; for illustration purposes, we’re staying in Tom’s World.) Wouldn’t you rather get paid $75 per visit versus waiving the copay and accepting only $50? Aren’t your services worth the full $75—if not more? And if the business reasons are not enough to sway you toward collecting [...]

New Medicare Advantage rules hold big potential for pop health

Healthcare Dive- Meg Bryant- June 13, 2018 The push toward valued-based care and population health management has raised visibility around nonmedical conditions that impact health outcomes. Improving health outcomes using population health strategies could get a major boost with a new Medicare Advantage rule taking effect this week. Payers will now be able to work with companies like Uber or Lyft to provide transportation, for example, as part of a more complete set of benefits for the quickly growing MA population. CMS issued a final rule in May giving MA plans more flexibility in determining the types of supplemental benefits they can offer chronically ill enrollees, including nonmedical benefits. The new policy, part of a broad 2019 Medicare payment rule, means plans like UnitedHealthcare and Humana aren't harnessed to a set palette of supplemental benefits for members with chronic conditions, but can tailor them to the specific needs of individuals. The rule could see an array of new benefits aimed at improving health outcomes by addressing issues such as housing and food insecurity, transportation and social isolation. Potential benefits include ride-hailing services, home visits, nutritional support, air conditioners for people with asthma, home renovations like grab bars and other accommodations to prevent falls, and home health aides. Providers have praised the expansion of benefits. “We now have a funding stream effectively within Medicare Advantage around social services,” Don Crane, president and CEO of America’s Physician Groups (APG), told Healthcare Dive in an interview. He called the change a “necessary and appropriate step” in managing chronic diseases. The focus on social determinants of health and population health management is part of the broader shift to value-based care and reimbursement. Some providers, payers and employers already offer wellness and prevention programs or [...]

Trump’s new insurance rules are panned by nearly every healthcare group that submitted formal comments

Los Angeles Times - By NOAM N. LEVEY -MAY 30, 2018 | 3:00 AM | WASHINGTON More than 95% of healthcare groups that have commented on President Trump’s effort to weaken Obama-era health insurance rules criticized or outright opposed the proposals, according to a Times review of thousands of official comment letters filed with federal agencies. The extraordinary one-sided outpouring came from more than 300 patient and consumer advocates, physician and nurse organizations and trade groups representing hospitals, clinics and health insurers across the country, the review found. Kris Haltmeyer, vice president of health policy and analysis at the Blue Cross Blue Shield Assn., said he couldn’t recall a similar show of opposition in his more than 22 years at the trade group, which represents Blue Cross and Blue Shield health plans and is among the organizations that have expressed serious reservations about the administration’s proposed regulations. “This seems to be a pretty overwhelming statement of concern,” Haltmeyer said. State insurance regulators from both political parties have also warned that the administration’s proposals could destabilize insurance markets, raise premiums for sick Americans and open the door to insurance fraud. And dozens of industry leaders and other experts have called on the administration to rethink moves to scale back consumer protections enacted through the Affordable Care Act, often called Obamacare. “Basically anybody who knows anything about healthcare is opposed to these proposals,” said Sandy Praeger, a former Republican state insurance regulator in Kansas and onetime president of the National Assn. of Insurance Commissioners. “It’s amazing.” Obamacare 101: A primer on key issues in the debate over repealing and replacing the Affordable Care Act. » After the failure to repeal the healthcare law last year, the Trump administration is [...]

By |May 30th, 2018|Blog, Commercial Insurance, Consulting, Credentialing, doctor, doctor Credentialing, Health Insurance, Healthcare Changes, Healthcare Professionals, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing, Staff Training|Comments Off on Trump’s new insurance rules are panned by nearly every healthcare group that submitted formal comments