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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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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 [...]

Good, Bad Trends in ICD-10 Coding Accuracy: Early 2016 Data Revealed

The Firm Services has the answers to all your ICD-10 issues. Written by Eileen Dano Tkacik | Monday, 20 June 2016 20:00 A recent data set gathered from 300 coders at 50 health systems was revealing with regard to ICD-10 coding accuracy thus far following the October 2015 implementation. The data exposed both good news and bad news for health information management (HIM) directors and coding managers. The good news is that coding accuracy is increasing slightly after eight months under ICD-10. But conversely, coding accuracy is nowhere near the 95-percent standards long ago established under ICD-9. So while accuracy ratchets up, the data demonstrates that many coding quality issues continue to persist. Measuring ICD-10 Quality Thus Far Our coding accuracy data was compiled from 300 coders using Central Learning, a Web-based coder assessment tool, and it includes input from experienced coders as well as coders-in-training. Fifty health systems are represented in the data, providing a broad-based assessment. We compared coder accuracy from the first quarter of 2016 (Jan. 1-March 31) to midway thru the second quarter (April 1 to May 27) to identify recent, timely trends in coder accuracy. Here is the most current benchmark of where we stand midway through the second quarter, as compared to the first.  As you can see, there has been an upward trend in coding accuracy, and we expect this to continue. Actively monitoring code quality, either through monthly coding audits or automated coder knowledge assessments, is critical to mitigate coding denials and revenue recoupment, as payor denials and recovery audits are expected to increase. Five Areas of Coding Accuracy Concern Digging deeper into the data from the first quarter, we pinpointed five areas in which [...]

The State of ICD-10 Implementation: Calm, and Qualms

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES                               Medscape Medical News- Robert Lowes  June 10, 2016 Now at almost the 9-month mark, the implementation of the new ICD-10 (International Statistical Classification of Diseases and. Related Health Problems, 10th Revision) diagnostic codes by physician practices resembles a calm, glassy stretch of ocean broken by a solitary shark fin. Yes, there is calm. By almost all accounts, the switch from the old ICD-9 codes to their more voluminous and complicated replacements has not produced a feared spike in rejected or denied insurance claims that would interrupt cash flow. Physicians who code claims and third-party payers that process them are mostly getting ICD-10 right. "We're not hearing from members that they are experiencing increased levels of denials," Robert Tennant, director of health information technology policy at the Medical Group Management Association, told Medscape Medical News. More succinctly, coding consultant and author Betsy Nicoletti told Medscape Medical News, "I haven't heard boo from my clients." However, a few experts have heard unsettling boos about rising denial rates, and almost everyone with something to say about codes and claims processing is apprehensive about what will happen after October 1. That date marks the end of a 12-month grace period set by Medicare and a number of large health insurers for tolerating less than perfect ICD-10 coding. If and when these payers bare their teeth over ICD-10, there could be blood in the water. There is another type of ICD-10 fallout to consider other than claims denials. A March survey by the Workgroup for Electronic Data Exchange found a slight decrease in productivity [...]

Obamacare’s 2017 Insurer Rate Requests Are Starting to Stream in…..

Insurers are dropping out of Obamacare. You have questions? We have answers at The Firm Services. It's been more than two years since the Affordable Care Act, which you probably know better as Obamacare, went into full effect for individual consumers, and in that time the new health law has enrolled about 12.7 million people. Note that this doesn't take into account the millions of Americans who've been able to get health insurance through the expansion of Medicaid and CHIP within their respective states. In total, 31 states chose to accept federal money and expand their Medicaid program to provide healthcare to low-income individuals and families. On the surface, Obamacare has led to a statistically meaningful reduction in the number of people who are uninsured. Gallup's most recent survey in the first quarter pegged the uninsured rate at 11%, which is down 90 basis points from the fourth quarter, and is 6.1% lower than Q4 2013, the quarter prior to the full implementation of Obamacare. The program has presumably opened the door for millions of lower-income Americans and those with pre-existing health conditions to get the medical care they need. But Obamacare has also opened the door to another set of problems that question its ongoing survival. An Obamacare exodus For instance, UnitedHealth Group (NYSE: UNH), the largest insurer in the U.S., recently announced that it would be vacating a majority of the 34 states it's currently operating in beginning in 2017. The reason? Higher member utilization rates and the ease with which consumers can change health plans are set to cause UnitedHealth to lose around $500 million on its Obamacare individual marketplace plans in 2016. Mind you, we're talking about the largest [...]

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 denials require attention

ICD-10 are you in Denial ? CARL NATALE APR 13, 2016 - 05:46 AM The U.S. healthcare system is not paralyzed by denial despite the ICD-10 implementation. Either the ICD-10 codes are not as burdensome as critics warned or relaxed specificity requirements are letting a lot of unspecified claims through. Even if ICD-10 denials aren't a tsunami of revenue disruption, they still are a challenge that should be monitored and mitigated. It's a challenge getting a handle on it. Allison Gilmore, principal data scientist for healthcare with Menlo Park, California-based Ayasdi, told Healthcare IT News that ICD-10 coding complicates the effort to analyze denial data in two ways: There are only six months worth of data to examine. Small sample size makes it harder to recognize trends. Because there are so many ICD-10 codes, the diagnoses are spread out. This sparsity creates lots of small sample sizes. But the data needs to be collected. For the Record magazine talks to Crystal Ewing, a senior business analyst and manager of regulatory strategy at ZirMed, and gets a couple tips for what to record in addition to diagnoses when it comes to denials: Specific reasons for denials Categories such as: payer procedure code diagnosis code coder patient access staff member scheduler case manager physician referring provider The article also makes the point that denial mitigation isn't all about the numbers and technology. People are at the heart of denial management. And it's not just medical coders who are expected to get the ICD-10 codes correct. Physicians need to understand how important it is to document medical necessity — which will be a major part of preventing denials. Are you in Denials ? Questions about ICD-10 codes and reimbursement? Physician Credentialing and Revalidation [...]

ICD-10 implementation hasn’t ruined healthcare yet

The Firm Services your best resource for ICD-10 issues. Carl Natale APR 8, 2016 - 05:58 AM There is a strong feeling that the ICD-10 transition has gone better than predicted. Not a lot of healthcare providers have come out and given us their disaster stories. Gabriel Perna did a decent roundup of ICD-10's first six months and cited a Physicians Practice survey that claimed 47.3 percent of readers weren't having any ICD-10 problems. I inserted the word claim because I'm doubtful the entire readership responded to the survey which makes the 47.3 percent stat doubtful. It's a semantic point I know. It is interesting that the survey also says the lack of problems includes a claim rejection rate as usual. That point is strengthened by citing a Navicure survey that claimed 60 percent of medical practices weren't seeing a revenue impact. Which is not what the American Medical Association was predicting. Perna backed that up by talking to a medical consultant and clearinghouse exec who say denial rates and revenue have been steady for their clients. As a separate testimonial, Deborah Winiger, who practices family medicine in Illinois, wrote, "As of now we have had no coding issues with insurance companies questioning or denying claims due to coding. " She credits credits her electronic health record (EHR) and a short list of ICD-10 diagnoses needed day-to-day for making ICD-10 coding manageable. Preparation also was a factor cited in Perna's story. Robert Tennant, director of health IT policy with the Medical Group Management Association (MGMA), told Perna that all those delays gave healthcare providers a chance to get ready. But Winiger has some awareness that healthcare payers may be giving her practice the [...]

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 [...]

New ICD-10 codes not likely to burden most providers

ICD 10 Codes? The Firm Services can help. By Joseph Goedert- Published - March 24 2016, 2:58pm EDT The recent federal announcement that about 5,600 new ICD-10 codes will be added in October may have some provider organizations worried they’ll face a heavy burden to accommodate such a large number of additions so soon after the transition to ICD-10. But it’s really not a heavy lift, those familiar with coding and the industry say. For the most part, financial, clinical and ancillary software vendors should be making the updates in electronic systems, says Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association. When a physician or coder enters a diagnostic term, after October 1, the systems should present additional code options after vendors update their product. However, if a physician coder works from a code book, they’ll need an updated book that contains the new codes. The last regular ICD-10 coding update came in 2011. Since then, ICD-10 codes haven’t been added, and the list of new codes has built up. Since 2011, there have been minimal updates, typically only for a small number of new codes that represent new diseases or technologies. For instance, more than a dozen codes were discussed in a recent meeting and under consideration for inclusion in October, Bowman says. The Centers for Disease Control, for instance, proposed a new code for Zika virus disease, A92.5, for implementation in the October update. It is not yet certain that the code will be included because a public comment period follows the proposing of codes, but it’s highly likely the Zika code will be included in the update, she believes. So overall, providers should not be [...]

Thousands of new ICD-10 codes slated for October 2016 release

Are you ready for the new 2016 ICD 10 codes ? By Greg Slabodkin  Published  March 15 2016, 2:47pm EDT The Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention have given the green light to adding 3,651 ICD-10 hospital inpatient procedure codes and about 1,900 ICD-10 diagnosis codes, beginning in fiscal year 2017. According to CMS, the coding update will be implemented on Oct. 1, 2016, and will include the “backlog of all proposals for changes to the code set proposed via the ICD-10 Coordination and Maintenance Committee process during the partial code freeze, and receiving public support.” The agency attributes the large number of new codes to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes that existed prior to the Oct. 1, 2015, ICD-10 transition deadline and which has now been lifted. The decision to add the codes was made at an ICD-10 Coordination and Maintenance Committee meeting last week. The new diagnosis codes will be included in the hospital inpatient prospective payment system proposed rule for fiscal year 2017, which is expected next month. There are a total of 75,625 valid ICD-10-PCS codes for the FY 2017 update, as of March 9, 2016. This includes 3,651 new codes which will be added, and 487 code titles which will be revised. Of the codes added, 3,549 new codes (97 percent of the total update) are cardiovascular system codes. And, of the new cardiovascular system codes, 3,084 new codes (84 percent of the total update) resulted from a group of proposals to create unique device values for multiple intraluminal devices and to apply the qualifier Bifurcation to multiple root operation tables for all artery body [...]

By |March 18th, 2016|Commercial Insurance, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Physician Credentialing|Comments Off on Thousands of new ICD-10 codes slated for October 2016 release