Request a Quote


Our Services


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.

­

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

How much is ICD-10 productivity hurting?

The Firm Services let us help you Code On ! Carl Natale MAR 11, 2016 - 06:15 AM One of the major concerns about ICD-10 implementation was how hard it would hit medical coding productivity. There were fears that U.S. healthcare would experience productivity losses of 40 percent like Canadian healthcare providers experienced in their ICD-10-CA transition. The Healthcare Billing and Management Association (HBMA) surveyed members in February and reported some numbers. They got 38 responses from revenue cycle management (RCM) companies and don't have a lot of confidence in this sample size. But there are two items worth considering: 22 respondents report a 10 percent increase in denials since Oct. 1. 22 respondents report a 25 percent decrease in coding productivity since Oct. 1. We're not sure how this shakes out but the survey results showed RCM providers that served anesthesia, primary care and radiology clients had the most problems. Oncology, emergency medicine and pathology clients had easier medical claim adjudication. If we want to trust that 25 percent productivity loss number, the ICD-10 transition doesn't seem so bad. But that would be like saying, "Yeah, you're in pain but it could be worse." So take some steps to ease that pain. Melanie Endicott offers a couple ideas to boost ICD-10 productivity: Increase training in the problem areas. Improving clinical documentation will move claims along. "Improving" clinical documentation sounds an awful lot like making physicians do more documentation. Giving them more to do that's not actually treating patients is a good way to make them unhappy. Which is why the best clinical documentation improvement is actually education. Training physicians is the best way to capture information that keeps medical coders from resorting [...]

By |March 11th, 2016|Commercial Insurance, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare|Comments Off on How much is ICD-10 productivity hurting?

ICD-10 transition still looking smooth

ICD-10 experiencing payment delays ? Non Payments ? CARL NATALE MAR 2, 2016 - 06:15 AM We're getting more data but it's not any easier to assess how the ICD-10 transition is going. Take a look at a few examples of data: RemitData is reporting that Fourth Quarter 2015 denials have increased slightly in February 2016 compared to January 2016. Relay Analytics reports that the denial rate has held steady at 1.6 percent since November. Relay Analytics also reports that Days to Payment — "number of days from statement through date until payment is received from the payer" — has been falling since January. It's now at 42.8 days. Relay Analytics' reimbursement rate is down to 27.7 percent. Maybe five months isn't enough time to plot some real trends. Will we be able to declare trends on April 1 when there is six months of data? What I find really interesting is Relay Analytics' list of slowest healthcare payers when measuring Days to Payment: 162.2 Days BLUE CARE NETWORK HMO 117.5 Days GEORGIA MEDICAID 105.3 Days VETERANS ADMINISTRATION FEE BASIS PROGRAMS 102.5 Days NEW JERSEY MEDICAID 88.2 Days SOUTH CAROLINA MEDICAID 88.1 Days UNITED RESOURCES NETWORK 87.1 Days LOUISIANA MEDICAID 84.2 Days PEOPLES HEALTH NETWORK 83.1 Days KAISER PERMANENTE of GEORGIA 81.8 Days KAISER PERMANENTE of COLORADO They also have denial rates for healthcare payers: 59.7 % MISSISSIPPI MEDICAID 17.1 % INDIANA MEDICAID 11.5 % WASHINGTON MEDICAID 7.5 % GATEWAY HEALTH PLAN - MEDICAID PA 6.7 % GREAT LAKES HEALTH PLAN 6.7 % MICHIGAN MEDICAID 5.8 % SOUTH CAROLINA MEDICAID 5.6 % GEORGIA MEDICAID 5.3 % NEVADA MEDICAID 5.2 % MEDICAL MUTUAL OF OHIO Just taking a quick look at these two charts, [...]

ICD-10 Works, but Concerns Remain Over Audits, Productivity

Let The Firm services assist you. By James Swann Feb. 24 — The switch to ICD-10 five months ago was uneventful, but concerns about provider productivity using the new codes and the threat of increased government audits remain among industry stakeholders. Specifically, providers need to make sure their claims contain enough detail to support the selected ICD-10 code, George B. Breen, an attorney with Epstein Becker & Green, in Washington, said. While Breen said it's too early to expect federal enforcement action involving ICD-10 coding, providers should expect the government to be focusing on appropriate clinical documentation to support claims coding. Providers need to look at ICD-10 through the prism of the increasing government focus on value-based payments, Breen said. “Health-care entities also need to anticipate and be prepared to respond to aggressive payer audits, both private and public,” Breen said. Providers are currently operating under a one-year grace period from the Centers for Medicare & Medicaid Services during which Medicare contractors won't deny claims as long as a valid ICD-10 code from the right coding family is used. The grace period means that a claim won't be denied if it isn't as specific as required under ICD-10. Breen said providers should take advantage of the time to create effective audit protocols that can address ICD-10 issues. “An open question that providers must determine an answer to is whether the grace period also permits that same flexibility in an overpayment analysis,” Breen said. While the grace period will prevent outright claims denials, Breen said, it's uncertain whether the CMS will offer a similar dispensation for any nonspecific ICD-10 claims that result in overpayments. The International Classification of Diseases, 10th Revision (ICD-10), which took [...]

Will the ICD-10 transition continue smoothly once CMS demands more specificity?

The Firm Services can help your office comply to ICD-10 February 22, 2016 | Carl Natale, Editor, ICD10Watch It's only a guess, but the ICD-10 transition doesn't look like it is taking down the U.S. healthcare system. So far, there are reports of minimal productivity drops and denial rate increases. But some reimbursement delays are being reported. It's not a perfect environment, but it doesn't appear to be a toxic one either. There's an argument to be made that close enough now counts in horseshoes, hand grenades and ICD-10 coding for Medicare. Since the Centers for Medicare and Medicaid Services (CMS) accepts codes from the correct ICD-10 family, some healthcare payers have followed suit. Reports suggest that as many as 25 percent of codes include the term unspecificied -- and that could be keeping denial rates in check. What's more, it's reducing pressure on healthcare providers to document a high degree of specificity. And they may be skipping some secondary diagnoses that don't affect reimbursement, according to Katherine Rushlau. Which would help physicians and medical coders keep records moving. There's a way to keep productivity up. (Or prevent it from sinking.) But is this going to work after Oct. 1, 2016? That's when CMS plans to require ICD-10 specificity. We don't know when private healthcare payers will want providers to get more specific. That's why Amy Sullivan, vice president of revenue cycle sales at PatientKeeper, is worried about more vigorous complaining and animosity when the specificity deadline approaches. The only way seen to prevent worse reimbursement problems is to improve clinical documentation that supports ICD-10 specificity and other healthcare payer initiatives that are coming. Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? [...]