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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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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 

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 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 [...]

ICD-101: Learn how to improve ICD-10 coding productivity

The Firm Services let us help you Code On ! by CARL NATALE - ICD 10 Watch.com - 10:32 AM Learning the  ICD-10-CM/PCS code set is going to take a lot of time. Cutting back on training is tempting when the ICD-10 implementation budget grows. Especially when you consider the hit to medical coding productivity that's coming. Which would be a mistake according to an American Academy of Professional Coders (AAPC) tip sheet: "The better educated and trained everyone is, the less of a productivity hit your practice will suffer, and a quicker recovery may be realized once we implement ICD-10." Here are some more tips to help you achieve ICD-10 proficiency: Have a Heart – Cardiac Overview: Coding cardiac conditions will be require brushing up on anatomy and physiology. (ICD-10 Tips and Resources - AAPC) Orthopedic Coding in ICD-10-PCS: Allografts and Autografts (Medical Billing and Coding Certification) Another ICD-10-PCS multiple procedure guideline: "Multiple procedures can also be reported during the same operative session when the physician performs multiple root operations with distinct objectives on the same body part." (ICD-10 Trainer) Differences from I-9 to I-10: Ventilation times: ICD-10-PCS has more options which might affect reimbursements. (IOD Blog) Use the (coding) force: Coding in ICD-10 Luke Skywalker's medical records. Hmmm. (ICD-10 Trainer) V84 to Z15: Don’t Expect Big Changes for Genetic Test Results: It's a one-to-one crosswalk. (SuperCoder Bolt) ICD-10-CM coding for late effects: How to report sequela codes. (ICD-10 Trainer) 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 or credentialing@thefirmservices.com

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 [...]

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 [...]

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 [...]

ICD-10 Increases in Claims Denials-Where denials are likely to hit medical practices.

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES CARL NATALE MAY 17, 2016 - 08:04 PM for ICD 10 Watch Healthcare providers should be getting ready for an increase in claim denials. It was mentioned earlier this week that healthcare payers may be simply gathering ICD-10 data they can use identify problems later — like after Oct. 1. This data could drive denial decisions. Speaking of data. If healthcare payers are going to be using data to find problems in medical practices, shouldn't medical practices start looking at data to find those problems first? That's what Debi Primeau did in her For the Record analysis of eight potential denial targets: Sequencing: Review the ICD-10-CM guidelines to make sure right ICD-10 codes are chosen for the primary diagnosis. Aftercare: The Z codes designate specific instances of aftercare. But usually it is correct to use the injury ICD-10 code with the seventh character designating a subsequent encounter. Seventh character:Speaking of subsequent encounters. It doesn't mean what many healthcare professionals think it does when they're trying to be clever. Unspecified codes:Yes, they do exist. But will auditors start looking for them? Laterality: It's great that ICD-10 codes allow to differentiate between the left and right sides of the body. But sometimes one bilateral code is needed instead of two diagnosis codes to designate the left and right side as affected. Hip and knee replacements: Use ICD-10-PCS codes for removal and replacement. Missing codes: This may get some physician push back. But the guidelines require supporting diagnoses in some cases. Medical necessity: This is going to require keeping up with local coverage determination (LCD) and national coverage determination (NCD) updates. If ICD-10 denials haven't been a problem, that doesn't [...]

By |May 20th, 2016|Commercial Insurance, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare|Comments Off on ICD-10 Increases in Claims Denials-Where denials are likely to hit medical practices.

Federal judge strikes down Obamacare payments

Richard Wolf, Gregory Korte and Jayne O'Donnell, USA TODAY 6:02 p.m. EDT May 12, 2016 WASHINGTON — Republicans won the first round Thursday in a separation of powers battle against President Obama that once again focuses on his most prized achievement: Obamacare. Federal district Judge Rosemary Collyer, a Republican appointee, ruled that the law did not provide for the funds insurers need to make health insurance policies under the program affordable. While the law provides for tax credits, she said, it does not authorize an appropriation for slashing deductibles and copayments. Without those reductions from insurers, many consumers could not afford to buy insurance. "Congress authorized reduced cost-sharing but did not appropriate monies for it,," Collyer said in her 38-page ruling. "Congress is the only source for such an appropriation, and no public money can be spent without one." Collyer blocked her own decision from taking effect while awaiting a likely appeal from the administration. Cost-sharing subsidies reduce consumers' insurance payments — an important feature of the Affordable Care Act, because deductibles are rising. Under the law, subsidies are available to people who earn between 100% and 400% of the federal poverty level, with extra assistance available for those up to 250%. For a family of four, that’s about $24,000 to $61,000. The Commonwealth Fund estimated up to 7 million people might have plans with cost-sharing reductions this year. The ruling does not represent as big a threat to the health care law as two previous conservative challenges swatted down by the Supreme Court in 2012 and 2015. The first would have gutted the law; the second would have eliminated tax credits in many states. “It’s a setback, and it’s a distraction … but a [...]