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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.


Obamacare 2017 enrollment hits record, despite Trump’s threat to repeal

Will Obamacare survive?   CNN Money by Tami Luhby @Luhby December 21, 2016: 5:19 PM ET Although President-elect Donald Trump has vowed to repeal Obamacare next month, a record number of people have signed up for coverage for 2017. Nearly 6.4 million Americans have selected Obamacare policies through the federal exchange for coverage starting Jan. 1, federal officials announced Wednesday. That's 400,000 more than had selected policies a year ago. The number of people opting for Obamacare is under more scrutiny than usual this year, since Congressional Republicans have pledged to dismantle it soon after Trump takes office on Jan. 20. Even before the election, there were concerns that customers would be deterred by price hikes -- the average premium for the benchmark silver plan soared 22% for 2017 -- and the fact that some insurers pulled out of the exchanges. However, administration officials sought to portray Obamacare as strong and crucial. Even if Trump and Republican lawmakers repeal the health reform law, they are likely to keep it in place for at least two to three years while they formulate an alternative. "Today's enrollment numbers confirm that some of the doomsday predictions about the marketplace are not bearing out," said Health Secretary Sylvia Burwell. "American people don't want to go backwards. They don't want to gamble with their healthcare during a repeal and delay." The pace of enrollments picked up closer to the deadline for coverage starting January 1, which was extended four days to Dec. 19 to accommodate demand. President Obama called attention to the fact that a record 670,000 people selected policies last Thursday. One worrisome sign is that fewer new consumers rushed to the exchanges than a year ago, when 2.4 [...]

Planned Medicaid Overhaul Could Put GOP Governors in an Awkward Spot

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services Wall Street Journal -By STEPHANIE ARMOUR Nov. 24, 2016 8:00 a.m. ET WASHINGTON—Republicans set on rapidly dismantling the Affordable Care Act are also pushing an overhaul of Medicaid, whose expansion under the 2010 law has covered millions of low-income Americans—many in states run by GOP governors. President-elect Donald Trump has proposed converting the federal-state program into block grants to the states in an effort to give them more latitude over how the program is run. This would jibe with many leading Republicans in Congress, who for years have wanted a Medicaid overhaul that hands more control over to the states. But such a move is likely to expose divisions among Republicans over how significantly to peel back coverage protections for the more than 12 million people who gained Medicaid in the 31 states, as well as Washington, D.C., that expanded the program. “Right now a lot of Republican governors expanded Medicaid and they have said they will fight to keep it,” said Caroline Pearson, a senior vice president at Avalere Health, a consulting firm. “You have to assume there will be some need for a solution for the 20 million who are better off under ACA, and most are in Medicaid.” Republicans are still in conversations about the shape and timing of any possible changes to the program. Any revisions would likely include a sunset or transition period, which would help people now covered through the expansion. It would also give states time to meet and plan for any changes, health policy analysts said. Meanwhile, the talk of an overhaul has left governors in a state of flux. South Dakota [...]

Repealing Obamacare Is Going to Take Forever, Admits Very Important Republican

Will Obamacare survive? Slate- By Jordan Weissmann- Nov.17, 2016 Republicans may control the White House and Capitol Hill, but repealing and replacing Obamacare is going to be a long and probably torturous process. How do we know? Because the GOP is already saying so. On Thursday, Senator Lamar Alexander of Tennessee admitted to reporters that the entire journey could take “several years.” Alexander's comments are worth special attention because, as chair of the Senate's Health, Education, Labor, and Pensions Committee, he is going to play an absolutely crucial role in any kind of health reform effort next year. And as of now, he's signaling that any legislation will need to contain some sort of bipartisan compromise. "Eventually, we'll need 60 votes to complete the process of replacing Obamacare and repealing it because Obamacare was not passed by reconciliation it was passed by 60 votes. And it was cleaned up by reconciliation because Scott Brown won his election," Alexander told reporters, according to Talking Points Memo. "Before the process is over, we'll need a consensus to complete it, and I imagine this will take several years to completely make that sort of transition to make sure we do no harm, create a good health care system that everyone has access to and that we repeal the parts of Obamacare that need to be repealed." There's lots to unpack in that paragraph. First, it's further confirmation that the Senate filibuster is going to survive during the Trump administration, a fact that should cheer Democrats who were worried they might spend the next two to four years getting steamrolled on every major piece of legislation. Second, Alexander for now seems to be rejecting the theory, pushed by [...]

President Floats Obamacare Fixes and Offers to Let GOP Rename It

NBC NEWS by JON SCHUPPE-OCT 20 2016, 5:10 PM ET President Obama on Thursday proposed a new round of tax credits and a government-run insurance plan for his healthcare reform program, fixes he said would correct jumps in some insurance premiums and the lackluster recruitment of young, healthy people. Obama delivered his message in Florida, singling out Gov. Rick Scott for his refusal to participate in Obamacare's offer to expand Medicaid coverage for poor people. If he and the governors of 18 other states took part, four million more people would be able to afford insurance, Obama said. Those corrections, he told an audience at Miami Dade College, would bring Obamacare much closer to reducing the number of uninsured Americans — a figure that currently stands at about 29 million people. He said he welcomed additional ideas from his Republican opponents in Congress, even if they wanted to rechristen it. "They can even change the name of the law to Reagancare," Obama said, drawing laughs from the crowd. "Or they can call it Paul Ryancare," Obama added, referring to the speaker of the U.S. House of Representatives. "I don't care — about credit. I just want it to work." As a prelude to his proposed solutions, Obama spent half of his 40-minute speech touting the Affordable Care Act, which many Republicans, including presidential candidate Donald Trump, have vowed to repeal. He pointed out that about 20 million more Americans have signed up for insurance since the program began offering state-based marketplaces and expanded Medicaid four years ago, bringing the uninsured rate to its lowest number in decades. But there have been many well publicized stumbles, including broken websites and dramatic increases in premiums, not to [...]

Obamacare Enrollment to See ‘Significant Slowdown’ Next Year

by Katherine Doherty Bloomberg News October 13, 2016 — 7:05 AM PDT Updated on October 13, 2016 — 8:55 AM PDT Enrollment in the Obamacare insurance marketplace is likely to stall or even decline for 2017 as higher premiums drive away people who aren’t eligible for government subsidies, according to S&P Global Ratings forecasts. “Our forecasted modest-to-negative growth is clearly a bump in the road, but doesn’t signal ‘game-over’ for the marketplace,” S&P analyst Deep Banerjee wrote in a report released Thursday. This November will be the fourth open enrollment period for individuals to choose insurance plans under the Affordable Care Act, President Barack Obama’s signature health-care law. The “significant slowdown” predicted by S&P would be another setback for ACA’s government-run insurance markets, after big insurers pulled out of many states because of mounting losses. ACA enrollment will range from 10.2 million to 11.6 million people after 2017’s enrollment season, which starts Nov. 1, S&P said. The lower end of the forecast range implies a decline of 8 percent compared with 2016 and the higher end a 4 percent gain. With premiums set to rise an average of 25 percent across the marketplace, according to data from, some current enrollees who aren’t eligible for tax credits may not re-enroll in 2017. Still, a moderation in premium increases beyond 2017 will likely bring growth back to the marketplace, according to S&P. “2017 will not be the year that expansion happens, however a flat year-over-year, or a slight decline should not be mistaken as game over,” analyst Banerjee said in an interview. Banerjee described next year as one step back and one step forward for the ACA. He expects lapses among people who don’t get subsidies, [...]

ObamaCare’s Meltdown Has Arrived

The Wall Street Journal-  By ANDREW OGLES and LUKE HILGEMANN Updated Oct. 6, 2016 12:50 p.m. ET With insurers pulling back, half of Tennesseans covered under the plan are losing their coverage. Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said. Then last week BlueCross BlueShield of Tennessee announced it would leave three of the state’s largest exchange markets—Nashville, Memphis and Knoxville. “We have experienced losses approaching $500 million over the course of three years on ACA plans,” the company said, “which is unsustainable.” As a result, more than 100,000 Tennesseans will be forced to seek out new coverage for 2017. BlueCross is only the latest insurer to head for the exits. Community Health Alliance, the insurance co-op established under ObamaCare, is winding down due to financial failure, leaving 30,000 people without coverage. UnitedHealthcare said in April it is departing Tennessee’s exchange after significant losses. That’s another 41,000 people needing new plans. All told, more than 60% of our state’s ObamaCare consumers will lose their coverage heading into 2017. When they go in search of a replacement plan, they will confront two unfortunate realities: a dearth of options and skyrocketing costs. Seventy-three out of Tennessee’s 95 counties will have only one insurer on the exchange, meaning no meaningful competition whatsoever. In regions where BlueCross BlueShield is pulling out, there will be two remaining major carriers, Cigna and Humana. The only large metro area with more options will be Chattanooga. Then there [...]

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 

Dems use ObamaCare crisis to revive ‘public option’ push

By Barnini Chakraborty Published September 07, 2016 President Obama and his Democratic allies are seizing on the exodus of private insurers from ObamaCare markets to renew their push for a so-called "public option" -- but Republicans say more "government intervention" is not the answer to the latest Affordable Care Act woes. A public option -- or insurance plan offered by the government -- had been written into early versions of the bill but failed to make the final cut in the law signed by Obama in March 2010. But with many states seeing private insurers exit ObamaCare markets amid concerns over cost and other factors, Democrats see a silver lining to what critics are calling another ObamaCare crisis -- a reason to bring the option back. “Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited,” Obama wrote last month in the Journal of the American Medical Association. The president called on his White House successor and Congress to implement the option. A former Obama health official, Ezekiel Emanuel, also backed up the president in a recent op-ed. And ex-Obama campaign manager David Plouffe added his support in an interview with NBC's "Meet the Press." If elected, Democratic presidential nominee Hillary Clinton says she’ll look for ways to improve ObamaCare, which includes supporting a public option. Her Republican rival Donald Trump and several GOP lawmakers, though, say the public option isn’t an option at all. Sen. John McCain, R-Ariz., who is seeking a 6th term, has been a vocal opponent of ObamaCare from the start and maintains “the whole thing is collapsing like a house [...]

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. [...]

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 [...]