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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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Platform Check: Trump And Clinton On Health Care

November 2, 2016 2:20 PM ET NPR-Heard on All Things Considered Alison Kodjak  When it comes to health care, the choice between Hillary Clinton and Donald Trump comes down to whether to keep, or trash, the Affordable Care Act. Premium Hike Catapults Obamacare Into Election Spotlight Trump says he wants to repeal and replace the health care law that is responsible for insuring about 20 million people, while Clinton has vowed to retain it and even expand its reach. Here are the candidates' plans: HILLARY CLINTON Keep and build on Obamacare Offer a tax credit of up to $5,000 to offset out-of-pocket costs over 5 percent of income Create a "public option" for health insurance Increase funding for community health centers Establish federal oversight of drug price increases Allow people to "buy in" to Medicare starting at age 55 Clinton's plan maintains the basic structure of Obamacare, with its expansion of Medicaid to more people with higher incomes and the ability to buy insurance through government-run exchanges. But she acknowledges problems with the program in its current form and offers changes to cut consumer costs, rein in drug prices, and ensure more uninsured people get covered. The so-called public option would allow consumers to buy health insurance directly from the federal government. It's proposed in most cases to ensure there are choices for buyers in places where only one insurance company offers policies through the Obamacare exchanges. Hillary Clinton Hitches Her Health Care Wagon To Obamacare An analysis of Clinton's plan by the Commonwealth Fund, a private foundation that supports independent health care research, concludes it would boost the number of people with health insurance by about 400,000. But the impact on the federal deficit [...]

Nine ICD-10 update tips

The Firm Services your best resource for ICD-10 issues ICD 10 Watch- September 23,2016 It's less than two weeks before U.S. healthcare providers are expected to use more updated ICD-10-CM/PCS. Update patient intake forms, insurance forms and superbills to include ICD-10 specificity. Make sure those forms aren't encouraging less specific ICD-10 codes. Lookup codes instead of relying on ICD-9 to ICD-10 code maps. By nature, code maps and crosswalks lead to less specific codes. Start choosing more specific alternatives. Reinforce ICD-10 training. Focus on learning how to code the most used diagnoses. Make sure electronic health record (EHR) forms and billing software are updated. Call your vendors and test the updates as soon as possible. Look for any trends with unspecified diagnosis codes. When and where are the unspecified ICD-10 codes being used? What can be done to make ICD-10 codes more specific? Review use of unspecified codes in top diagnoses. It's worth the time making sure more specific diagnoses are being assigned. Make sure clinical documentation can support more specificity in coding. Medical coders cannot assign specific ICD-10 codes if clinicians are not documenting the details needed. Review the ICD-10 guidelines. There are more than codes to update. Track denials. Maybe healthcare payers already are requring more specific ICD-10 codes. Some basic steps will make sure ICD-10 coding remains manageable after Oct. 1. Questions about ICD-10 codes and reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 

Aetna to cut back 70% on Obamacare plans in 2017

Have questions about Obamacare and Aetna ?Call us we can help. Aetna is sharply cutting its participation in Obamacare exchanges for 2017. The health insurer said it will offer individual Affordable Care Act exchange plans in just four states, down from 15 this year, in an effort to reduce its losses. "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision," Chairman and CEO Marc Bertolini said in a statement. The insurance giant says it will offer ACA exchange plans in Delaware, Iowa, Nebraska and Virginia, slashing its Obamacare footprint by 70 percent next year. It will offer ACA plans in just 242 counties nationally, down from nearly 780 this year. Aetna's announcement comes two weeks after the company booked $200 million in ACA-related pretax losses in its Q2 earnings report and nearly one month after the Department of Justice's antitrust division sued to block the health insurer's acquisition of rival Humana. Humana has also announced it will sharply cut back from the exchanges. Its pullback, in the wake of UnitedHealth's departure from all but a handful of exchanges, means that hundreds of thousands of Obamacare plan members will no longer have access to plans from the nation's three major insurers in 2017. Aetna has been one of the largest Obamacare players since the launch of the exchanges two years ago, offering plans in more than two dozen states. The Obama administration's chief executive of the federal marketplace attributed the insurer's departure to the forces of competition in an evolving insurance market. "Aetna's decision to alter its Marketplace participation does not change the fundamental fact that the Health Insurance [...]

Medicaid estimate renews cost concerns over Obamacare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services Tribune news services Contact Reporter- August 12,2016 - 8:55 am The cost of expanding Medicaid to millions more low-income people is increasing faster than expected, the government says, raising questions about a vital part of President Barack Obama's health care law. The law called for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year. Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things. In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated. "We were told all along that the expansion population would be less costly," said health economist Brian Blase with the Mercatus Center at George Mason University in Virginia. "They are turning out to be far more expensive." Blase previously served as a GOP congressional aide. The new estimates could be a warning light for Democrat Hillary Clinton, who has promised that if elected president she would work to expand Medicaid in the remaining 19 states that have not done so. Higher costs would make it harder for a President Clinton to sell Obama's full-financing plan to Congress. Under the law, people making up to 138 percent of the federal poverty line — roughly $16,390 for an individual and $33,530 for a family of four — are eligible for Medicaid at little or no cost to them. An estimated 9 million to [...]

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. [...]

Calling Cadillac Tax A Lemon, Congress Moves To Repeal Core Of Obamacare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services JUL 15, 2016 @ 09:08 AM - Forbes -Robert Wood More than 300 members of the House support legislation to repeal the Cadillac tax. The Cadillac tax is a 40% tax on the cost of employer-sponsored health coverage exceeding certain thresholds. Those ‘Cadillac’ thresholds are actually more Yugo territory: $10,800 for self-only coverage, and $29,100 for family coverage. What’s more, the cost of wellness programs, on-site clinics and other plan features meant to reduce expenses are also included. The result is that vast number of participants in numerous employer-sponsored plans will be affected. There are two bills in the House, H.R. 879 introduced by Rep. Frank Guinta (R-NH), and H.R. 2050, introduced by Rep. Joe Courtney (D-CT). The House and Senate may actually do it this time. Those favoring repeal come from all corners. But a major advocate for repeal is the Alliance to Fight the 40, a coalition of public and private employers, patient advocates, businesses, unions, and more. And they are racking up the votes and sponsors. The Supreme Court upheld Obamacare as a tax law, and it contains many taxes, including the Cadillac tax. It is a whopping 40% on top of all other federal taxes. It had a clever delayed effective date that was supposed to make it easier for all of us to swallow. Obamacare was passed in 2010, but the Cadillac tax was deferred until 2018. Later, Congress rolled it back two more years, to 2020. That delayed effective date clearly de-emphasized the importance of the provision. But when it does hit, it will hit with a vengeance. It was supposed to target overly generous employer-provided health care plans. That doesn’t just mean for executives. In fact, the tax mostly appears to hit union [...]

Illinois suspends insurer’s Obamacare payments until feds pay up

Let the Experts at The Firm Services assist your practice. By Lauren Clason - 07/07/16 07:49 PM EDT A cash-strapped Illinois health insurer won’t be sending Obamacare payments to Washington until the feds pay their bill first, according to the state’s top insurance official. The acting director of the Illinois Insurance Department is preventing Land of Lincoln Health, the state’s troubled Consumer Operated and Oriented Plan (CO-OP) from paying money owed under the Affordable Care Act unless Washington hands over funds the insurer says are due under a separate but similar provision of the law. Anne Melissa Dowling said in a June 30 letter to ACA Marketplace CEO Kevin Counihan she is suspending payments of nearly $32 million that Land of Lincoln Health owes the Centers for Medicare and Medicaid Services under the risk-adjustment program, one of the law’s premium stabilization programs designed to soften the blow of heavier regulations. Land of Lincoln Health is currently suing the federal government for $73 million it claims it’s owed under a similar program known as risk corridors. Paying the CMS bill would force the state to liquidate Land of Lincoln, Dowling said, which “would trigger marketplace disruption and extreme financial harm” to the CO-OP’s 49,000 members. Dowling signed a June 27 order preventing the CO-OP from making payments until CMS fulfills its risk-corridor program obligations. The Illinois CO-OP in June became the latest insurer to sue the administration after the federal government announced last fall it would pay only 12 percent of the $2.87 billion in risk-corridor payments sought by insurers in 2015. The payments were cut after Congress enacted a bill that rendered the program budget-neutral, preventing the agency from pulling funding from other [...]

ICD-10: Preventing Medical Necessity Denials

The Firm Services has the latest information regarding ICD-10 and its implementation.  Written by Daria Bonner, CHCA, CCP, RMC | Monday, 23 May 2016 00:00 Given the added specificity inherent in ICD-10, it’s no surprise that medical necessity denials for physician practices and medical groups are expected to increase throughout 2016. In addition to greater levels of code granularity, three key industry drivers are expected to impact ICD-10 coding compliance among physician practices in the year ahead. First, payers will continue to refine coverage policies based on the new code set. Second, the ICD-10 grace period for physician practices comes to a close as of Oct. 1, 2016. And finally, almost 6,000 new ICD-10 codes will be added that same day as the partial code freeze concludes. These factors will impact all providers, but they will be especially notable within physician practices and medical groups. Practices are also predicted to struggle with reporting ICD-10-CM diagnosis codes that aren’t medically necessary as it pertains to supporting the corresponding CPT codes. Without proactive planning, the following three specialties may see an increase in medical necessity denials in the months ahead: Cardiology Pathology/Laboratory Radiology This article takes a closer look at these specialties to identify common medical necessity gaps in physician documentation and clinical coding. Left open, these gaps carry the potential to increase denials, audits, and revenue loss in 2016. Cardiology Concerns With 42 national coverage determinations (NCDs), cardiology is both a high-volume and a high-value service line. While CPT and E&M codes prevail in cardiology claims, the correct assignment of an ICD-10 code drives medical necessity decisions through NCDs. Some cardiology practices are already experiencing medical necessity denials related to the following: Unspecified codes Incomplete codes [...]

Credentialing is a big pain for doctors! Let The Firm Services professionals do it for you.

By Gus Geraci, MD Gus Geraci, MD, is consulting chief medical officer for the Pennsylvania Medical Society. We all know how hard it is to recruit a physician these days. No matter the specialty, finding a compatible physician with the right skills is a major challenge. There’s more on this particular subject coming soon from me in the February 2016 issue of the Pennsylvania Physician magazine, but let’s just assume you’ve overcome all those challenges and actually managed to sign a contract. Let’s put the physician to work! Right? Sure, you can see patients, but there’s a major problem: Getting paid for that. Oh, you did want to get paid, right? So what do you need to do? Insurers have to credential you – that’s each and every insurer for each patient you see. As a family doc, my practice had contracts with something like 50 or more different insurers. Realistically, there are probably only two or three that dominate the market where you work, and they’re the important ones. But each and every insurer has to go through this process. It’s very similar. They have to confirm your identity, your credentials and skills. You’ve hired the physician, and they submitted their credentials (which by the way, is a tremendously laborious and repetitive process), and now it sits in the insurer’s hands. Your start date comes and goes, and you either can’t see that insurer’s patients, or you are welcome to see them but you won’t get paid by the insurer, because until you are credentialed you are not in their network. Depending on their rules, the patient may get stuck paying more (because you’re out of network), or you may have seen that patient [...]

By |April 29th, 2016|Blog, Commercial Insurance, Consulting, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, Physician Credentialing, Uncategorized|Comments Off on Credentialing is a big pain for doctors! Let The Firm Services professionals do it for you.

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 [...]