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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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HHS Inspector General Issues Physician Compensation Medicare Fraud Alert

Physicians Credentialing Doctors for Medicare HHS Inspector General Issues Physician Compensation Medicare Fraud Alert posted on: Wednesday, June 17, 2015 The Office of the Inspector General of the Department of Health and Human Services (“OIG”) issued a warning earlier this month to physicians. The OIG enforces healthcare laws including the Stark Law and Anti-Kickback statute. Federal law prohibits hospitals from offering anything of value in exchange for certain healthcare business. Physicians can be paid for their services but not for sending Medicare patients to hospitals. In recent years, there have been many prosecutions of hospitals for violating anti-kickback rules. Long gone are the days when a hospital would reward doctors bringing in patients with a cash bonus. Now, the “kickbacks” or bribes are more concealed. Compensation agreements between hospitals and doctors are always scrutinized carefully. On June 9th, the OIG issued a written fraud alert to warn hospitals and doctors of new schemes that they see as problematic. This is only the fourth time in five years that the OIG issued a written fraud alert. According to the Department of Health and Human Services, doctors who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for services actually provided. Even if a compensation package is otherwise legal, it can still violate the law if just one of its purposes is designed to compensate the physician for bringing in Medicaid or Medicare patients. The written guidance specifically addresses “medical directorship” arrangements.  The OIG believes some doctors are being given titles and extra pay simply because they bring in more patients. To avoid violating the law, a doctor offered a directorship must actually perform the duties of [...]

CMS Releases Medicare Cost Data on Physicians. Now What?

Credentialing, Revalidation Services professionals at The Firm Services Jacqueline Fellows, for HealthLeaders Media , June 4, 2015 Data limitations don't give an accurate picture of what Medicare reimbursement really means for physicians. But patients are increasingly aware of healthcare costs, and physicians should not shy away from a conversation. The report released this week by the Centers for Medicare and Medicaid Services detailing that over 950,000 providers were paid $90 billion for medical services they provided to Medicare beneficiaries in 2013 has spawned sensational headlines about Medicare's millionaire doctors. The headlines aren't wrong, but it's a small group of physicians that are garnering the attention of many. To prevent an inaccurate narrative, doctors may need to prepare for patients' questions. This is the second time CMS has released physician-specific data for Medicare payments in an effort be more transparent. In a prepared statement, American Medical Association President Robert Wah, MD, commended CMS for its effort, but criticized the agency for giving so little context to what the data means for patients. "Specifically, the data released today do not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions … [or] enough context to prevent the types of inaccuracies, misinterpretations, and false assertions that occurred the last time the administration released Medicare Part B claims data." It's true that the data has many limitations. For one, there is no information that gauges quality. It also shows information only on Medicare services. Depending on the payer mix of a physician office, Medicare beneficiaries could be a minority or majority. Geographic variation in payment amounts isn't accounted for. Despite the criticism and the limits of the data, [...]

2015 Medicare Changes, How does it affect your practice?

Physicians Credentialing Doctors for Medicare 2015 Medicare Changes From APTA - May 21,2015 Scroll down this page for info on topics including the Medicare fee schedule and therapy cap, SGR, PQRS, functional limitation reporting, and more. New Year, New Changes Following years of advocacy by physicians, physical therapists, and other health care professionals, Congress passed a bill to repeal the flawed SGR formula on April 14, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 came a little more than a year after President Obama, on April 1, 2014, signed into law the Protecting Access to Medicare Act of 2014, the last in a long line of annual temporary "fixes" that prevented a large payment cut for physicians, physical therapists, and other health care professionals from taking effect. The 2014 law also extended the therapy cap exceptions process until March 31, 2015, and the April 14, 2015, repeal law further extends the exceptions process to December 31, 2017. In addition, a number of changes included in the 2015 Medicare Physician Fee Schedule final rule affect physical therapist practice and payment for 2015. Changes that are in effect regarding fee schedule payment rates include the following: From January 1-June 30, 2015, there is a slight change from 2014 in the conversion factor for providers. The 2015 conversion factor for the first 6 months is $35.7547 as mandated by legislation. (The 2014 conversion factor was $35.8228.) Effective July 1, 2015, there will be a .5% update to the payment rates for the remainder of the year and an extension of the existing 1.0 geographic practice cost index (GPCI) work floor. Changes in effect regarding the therapy cap include the following: The therapy cap amount [...]

By |May 28th, 2015|Commercial Insurance, Healthcare Professionals, Medicaid, Medical Billing, Medical Credentialing, Medical Insurance, Medicare|Comments Off on 2015 Medicare Changes, How does it affect your practice?

Grassley to Justice Department: Crack Down On Medicare Advantage Overbilling

Medicare Advantage MAY 20, 201511:57 AM ET- Center for Public Integrity Senator Grassley asks the Justice Department to crackdown on Medicare Advantage billing. Senate Judiciary Committee Chairman Chuck Grassley has asked Attorney General Loretta Lynch to tighten scrutiny of Medicare Advantage health plans suspected of overcharging the government, saying billions of tax dollars are at risk as the popular senior care program grows. In May 19 letters to Lynch and Andrew M. Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, Grassley wanted to know what both agencies have done, together and apart, to stamp out overcharges that have plagued the privately run insurance program for years. "Safeguards become all the more important as Medicare Advantage adds more patients and billions of dollars of hard-earned taxpayer money is at stake," the Iowa Republican wrote. Medicare Advantage plans have gained popularity as an alternative to the government-run Medicare program in recent years, and the plans now cover some 16 million people. Grassley cited the Center for Public Integrity's investigative reporting, which found that CMS made more than $70 billion what the agency itself deemed "improper" payments to Medicare Advantage plans between 2008 and 2013. The concerns revolve around the accuracy of a billing tool called a "risk score," which is supposed to pay insurers higher rates for taking sicker people and less for those with few medical needs. But federal officials have struggled for years to track overspending tied to inflated risk scores. A 2009 agency study found that some plans had exaggerated how sick patients were to boost their payments, for instance. CMS also has acknowledged that faulty risk scores remain a costly problem, as the Center for Public Integrity first reported last year. "With the reported increase in risk score gaming, [...]

By |May 21st, 2015|Commercial Insurance, Medicaid, Medical Billing, Medical Credentialing, Medical Insurance, Medicare, Uncategorized|Comments Off on Grassley to Justice Department: Crack Down On Medicare Advantage Overbilling

Big change coming soon for high income Medicare beneficiaries

Buried in the new “Doc Fix” law are provisions that will adversely affect some folks on Medicare May 13, 2015 @ 3:42 pm - By Katy Votava http://www.investmentnews.com/article/20150513/FREE/150519958/big-change-coming-soon-for-high-income-medicare-beneficiaries Physicians Credentialing Doctors for Medicare Higher-income Medicare beneficiaries have been paying more for their Medicare Parts B and D coverage for several years in the form of income-related monthly adjustment amounts. As a result of a new bill that sailed through Congress with bipartisan support and was signed into law by President Barack Obama in mid-April, costs for upper-income Medicare beneficiaries will increase soon. The legislation is officially called the Medicare Access and CHIP Reauthorization Act of 2015, otherwise known as the “Doc Fix” law. The major focus of this law is to permanently repair the long-broken method of paying doctors under Medicare, secure permanent funding for low-income Medicare recipients and ensure that children will be able to get access to health coverage. Buried in the law are other provisions that will adversely affect some folks on Medicare. One of those provisions is that the scale for setting the Medicare B and D IRMAAs will change dramatically in the near future, resulting in more high-income individuals paying sizable IRMAA amounts. This recent law changes that scale in the near future resulting in more beneficiaries paying the top IRMAA levels sooner than is currently the case. Keep in mind that the modified adjusted gross income determination by the Social Security Administration in any year is drawn from the tax return two years prior. Case in point, while the law stipulates that new MAGI tier definitions go into effect 2018, the 2016 tax return will be used to set those 2018 IRMAA payments. There have been dramatic changes [...]

By |May 14th, 2015|Commercial Insurance, Consulting, Healthcare Changes, Medicaid, Medical Credentialing, Medical Insurance, Medicare, Press|Comments Off on Big change coming soon for high income Medicare beneficiaries

Medicare Information from the AAFP- Physicians here are your options below.

Physicians Credentialing Doctors for Medicare Medicare Information from the AAFP Revised April 23, 2015 Please note: The following was developed from documents provided by the AMA and contains excerpts from the AMA-published Medicare RBRVS: The Physician's Guide 2013. On Thursday, April 16, 2015, the president signed into law H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which reversed cuts to Medicare physician payments that technically went into effect on April 1, 2015, based on the sustainable growth rate system, which the law also repealed. The law maintains Medicare payment allowances in effect before April 1 through dates of service including June 30, 2015. For dates of service beginning July 1, 2015, the law provides a 0.5% increase in the Medicare payment rate. To help ensure that physicians are making informed decisions about their contractual relationships with the Medicare program, the American Medical Association (AMA) has developed a “Medicare Participation Kit”(www.ama-assn.org) that explains the various participation options that are available to physicians. The AAFP is not advising or recommending any of the options. The purpose of sharing this information is merely to ensure that physician decisions about Medicare participation are made with complete information about the available options. Please note that the summary below does not account for any payment adjustments that a participating or non-participating physician may incur through one of the Medicare initiatives, such as the Physician Quality Reporting System. Physicians wishing to change their Medicare participation or non-participation status for 2015 are required to do so by December 31, 2014. Participation decisions are effective January 1, 2015, and are binding for the entire year. The Three Options There are basically three Medicare contractual options for physicians. Physicians may [...]

By |May 7th, 2015|Commercial Insurance, Medicaid, Medical Credentialing, Medical Insurance, Medicare, Physician Credentialing|Comments Off on Medicare Information from the AAFP- Physicians here are your options below.

Obama signs overhaul of how Medicare pays doctors.