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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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Doctor challenges how physicians are evaluated

Physician Credentialing Certification Services at The Firm Services San Diego Union Tribune- By Paul Sisson | 2:37 p.m. Nov. 14, 2015 Dr. Paul Teirstein led a coalition pushing back against unpopular certification rules. In less than two years, Dr. Paul Teirstein of San Diego has led a coalition in convincing the powerful American Board of Internal Medicine to apologize for, and ultimately suspend, unpopular certification rules that would have affected more than 200,000 physicians nationwide. Not content with that success, he and a group of other doctors affiliated with organizations such as Harvard University and the Mayo Clinic have launched their own competing nonprofit to issue board certifications. The San Diego-based National Board of Physicians and Surgeons has issued board certifications to more than 2,700 practitioners. Dr. Ashish Jha, director of the Harvard Global Health Institute and an outspoken advocate for better accountability and transparency in health care, said while the fledgling organization is still tiny compared to its rival, it has the potential to make real change. “The truth is that it remains small and while it’s growing quickly, it is far from posing a real threat to ABIM. That said, I’m glad that they are there, and by offering credible competition to ABIM, the NBPS can make everyone better,” Jha said. “It will force ABIM to more clearly articulate its value to physicians.” Teirstein said only 18 hospitals currently accept the new board’s certifications for the purposes of granting privileges to do surgeries and other treatments, but that the number is rising. In San Diego County, his own hospital affiliate, Scripps Health, is considering acceptance. Teirstein, an interventional cardiologist and chief of cardiology at the Scripps Clinic in La Jolla, has attracted [...]

End Of Medicare Bonuses Will Cut Pay To Primary Care Doctors

HEALTH INC. November 28, 2015-7:03 AM ET : Michelle Andrews Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all. The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 report by the Medicare Payment Advisory Commission. Although that may sound like a small adjustment, it can be important to a primary care practice, says Dr. Wanda Filer, president of the American Academy of Family Physicians. "It's not so much about the salary as it's about the practice expense," she explains. "Family medicine runs on very small margins, and sometimes on negative margins if they're paying for electronic health records, for example. Every few thousand makes a difference." Doctors in family medicine, internal medicine and geriatrics are eligible for the bonuses, as are nurse practitioners and physician assistants. Medicare generally pays lower fees for primary care visits to evaluate and coordinate patients' care than for procedures that specialists perform. The difference is reflected in physician salaries. Half of primary care physicians made less than $241,000 in 2014, while for specialists the halfway mark [...]

Why are Incorrect Characters a Top ICD-10 Coding Challenge?

Rev Cycle Intelligence- By Jacqueline DiChiara on November 17, 2015 “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant." Lack of training for inpatient procedural coding may pose a significant challenge for the healthcare industry as 2015 comes to a close, said Teri Jorwic, ICD-10 Educator and Professor of Healthcare Informatics at the University of Illinois at Chicago, to RevCycleIntelligence.com in an exclusive interview last September. icd-10-cm coding characters Jorwic caught up once again with RevCycleIntelligence.com to assess what has been happening across the greater healthcare space in regard to procedural coding concerns over the past month and a half. “The two main things I’ve heard so far have to do with either linking and LCDs [Local Coverage Determination] or NCDs [National Coverage Determination], particularly having to do with the injury codes and the seven characters,” Jorwic states. Questions about whether or not the coverage is the same post-October 1, 2015 are common, says Jorwic, who confirms coverage policy changes are on the horizon. “They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant,” she says. Physical therapists, for instance, may struggle to determine differences between “initial” and “sequela,” as they often deal with a subsequent portion of injury when a patient enters regular recovery. Another problem now popping up involves new guidelines for the often perplexing Excludes1 notes, says Jorwic. “There is a new guideline in ICD-10-CM – the diagnoses side that says if you have an Excludes1 note, you cannot code conditions that appear in that Excludes1 notation together,” says Jorwic. “So, the classic example would be, for example, a patient that [...]

How to improve queries for ICD-10 claims

by CARL NATALE  OCT 28, 2015 - 05:51 AM U.S. healthcare is waiting to see how ICD-10 implementation affects reimbursements. The fear is that ICD-10 claims will be denied at a greater rate than before Oct. 1 — either by design or error. And that is going to trickle down to physicians in the form of queries. And if a medical practice wants to avoid an increase in denials, it needs to help physicians provide more clinical detail to support the proper ICD-10 codes. That will most likely come in the form of queries. Do you really need to query? But medical coders need to make sure they really need to query. Pamela Haney lists four tests of whether an ICD-10 query is needed: Does the medical record contain conflicting information? Are there elements or information missing from the medical record? Are there conditions or procedures that need more detail to support a specific ICD-10 code? If there is an unspecified diagnosis, is there information that suggests a more specific diagnosis is possible? The Journal of AHIMA published guidelines that explain writing a query is needed when clinical documentation: "Is conflicting, imprecise, incomplete, illegible, ambiguous or inconsistent" Describes clinical indicators that don't clearly support the underlying diagnosis Includes clinical indicators, evaluation, and/or treatment that does not seem related to any medical condition or procedure Does not support or validate a diagnosis Does not support the present on admission indicator If you have to query Review some quidelines on how to write better queries for information that supports ICD-10 coding: Be written in clear, concise and precise language Contain evidence specific to the case Be non-leading Be part of the clinical documentation Include ICD-10 language But [...]

Smooth Rollout For New ICD-10 Medical Codes, Insurers Say

FORBES/ Pharma & Healthcare OCT 13, 2015 @ 07:55 AM Bruce Japsen ,CONTRIBUTOR The launch of tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the billing process has seen few problems in the early days of its launch, large health insurers say. The news of a smooth rollout thus far comes from Humana HUM +0.52% (HUM) and UnitedHealth Group UNH -0.16% (UNH) despite reports that one in four doctor practices weren’t ready for the October 1 transition to International Classification of Diseases, Tenth Revision, known as “ICD-10.” After two years of delays, medical care providers had to be ready at the beginning of this month for the conversion to 140,000 new codes that they will use in order to bill government and private insurers. The delays to help doctor practices get ready seem to have paid off. “The extra time has helped,” Robert Tennant, health information technology policy director at the Medical Group Management Association told more than 200 doctors at a panel featuring insurers at the group’s annual meeting in Nashville this week. Humana (HUM) said calls in the first week into the insurer that were specific to ICD-10 amounted to “only 0.03 % of all calls from providers regarding benefits, claim status, spanning date of service, and authorization.” Pediatrician Lanre Falusi examines an infant’s ear in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland. Photographer: Andrew Harrer/Bloomberg  Lanre Falusi “It’s been a pretty smooth transition so far,” Sid Hebert, who heads the ICD-10 implementation team at Humana (HUM) said. “We are about ten days into this and already have 50% of our claims coming in. Almost everyone who is [...]

CMS will reimburse ICD-10 mistakes for one year after transition deadline

ICD-10 is coming October 1st. Are you ready? By Virgil Dickson  | July 6, 2015 Modern Healthcare –“The leader in healthcare business news, research & data” The CMS has made a concession in the transition from ICD-9 to ICD-10. For one year past the Oct. 1, 2015 deadline, the CMS will reimburse for wrongly coded claims as long as that erroneous code is in the same broad family as the right one. There had been concerns among providers that they wouldn't be paid if they made minor mistakes trying to implement the new complex coding system. That may be why the American Medical Association had a change of heart recently in getting providers on board. The association, a longtime critic of the Obama administration's mandate to move from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, has announced its teaming up with the CMS to make the transition easier for providers. The two parties plan to conduct a nationwide outreach effort to educate providers through webinars, on-site training, educational articles and calls to help physicians and other providers get up to speed before the Oct. 1 deadline. Just two months ago, the AMA voiced support for a bill crafted by Republican Texas Rep. Ted Poe that would prohibit HHS from replacing ICD-9 with ICD-10. For years, the organization has questioned the need for the transition and noted that complying with the new codes could cost providers three times more than previous estimates. Texas' state medical association, the largest in the country, has vigorously fought the implementation, arguing that doctors have been subject to a recent onslaught of costly government edicts that threaten to drive more physicians out of business. An AMA spokesperson said the change of [...]

Emergency cash a must for ICD-10

ICD-10 is coming October 1st. Are you ready? Extra funds can go a long way to relieving anticipated headaches of code change Healthcare providers may face disruptions in their payments even if they are on target to operate using ICD-10 codes on Oct. 1, 2014. Since providers will, and indeed need, to be able to pay rent and staff salaries if the transition does not flow as smoothly as testing has indicated, experts advise having up to several months' cash reserves or access to cash through a loan or line of credit to avoid potential headaches. "Just figure that with the transition to ICD-10 there will be delays in reimbursement," said April Arzate, vice president of client services at MediGain, a Dallas-based revenue cycle and healthcare analytics company. Although there will be a great deal of testing and preparation done by the vendors of practice management and electronic health record (EHR) systems by clearinghouses and payers, "we really won't know the true effect until they turn it on," Arzate added. Mitigate revenue disruption The recommendation that Arzate pointed to is to reserve at least enough money to cover medical supplies, payroll, rent, everything required to keep the practice operational for three to six months — just in case any payers experience disruptions in cash flow that delay payments. That's especially difficult for small practices. "You may not have to have it on hand," Arzate explained, "but you need to have the resources available." It's better to talk with the bank now before the funds are needed, added Clint Hughes, MediGain vice president of marketing. "The bank will be more open now than if you come to them desperate because you're two months behind," he said. Arzate suggested that they establish [...]