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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.


How is ICD-10 affecting claim denials?

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES ICD 10 WATCH CARL NATALE JAN 27, 2016 - 06:00 AM There are some mixed messages on how much claim denials have risen since Oct. 1. Some healthcare providers are reporting a few ICD-10 denials but not enough to worry about. On the other hand, a healthcare consultant found out that a California HMO was denying medical claims on a massive scale. And NCDs and LCDs have needed tweaks to prevent mistaken denials. If this isn't a major national problem, it certainly can be a major problem for individual medical practices. So it needs to be fixed. First, measure ICD-10 claim denials and monitor revenue-based metrics. It is important to understand where the problems are occurring. Then medical practices can start fixing the problems that create denials. Second, figure out if the right ICD-10 codes are being used. There is lots of room for error so make sure the medical claims are coded correctly and clinical documentation supports the diagnoses. Keep investing in coding training. Third, keep calling the healthcare payers until they answer questions. Do not let any denial go because it's too much work. Best advice: Prevent denials Chris Nerney at Revenue Cycle Insights identifies three things that can help healthcare providers prevent claims denials: Registration processes: Denial problems can start before the first ICD-10 code is recorded. Medicaid: Which comprises 13 percent of all denials. Start by checking eligibility, medical necessity and pre-authorization. High-impact specialties: Specialties contribute heavily to major amounts of claim denials. (Repeat the advice in the first two tips). In a way, the macro claim denial statistics don't matter as much as the individual anecdotes. Those stories are [...]

Cigna temporarily banned from new Medicare plans

USA Today Nathan Bomey January 23, 2016 U.S. regulators have temporarily banned health insurer Cigna from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings. The insurer disclosed late Thursday in a public filing that the U.S. Centers for Medicare and Medicaid Services (CMS), had suspended the company from enrolling new customers or marketing plans for Cigna Medicare Advantage and Standalone Prescription Drug Plan Contracts. In an enforcement letter, CMS accused Cigna of "widespread and systemic failures," including the denial of health care coverage and prescription drugs to patients who should have received them. The actions "create a serious threat to enrollee health and safety," said CMS, which is requiring Cigna to appoint an independent monitor to audit its handling of the matter. The sanctions, which took effect at the end of the day Thursday, do not affect patients who are already enrolled. CMS said could not provide an estimate for how many patients were affected. Cigna had market share of 3% in Medicare Advantage plans in 2015, representing about 502,000 patients, according to the Kaiser Family Foundation. “As a company committed to delivering quality products and services, we focus on putting customers first. The findings in the audit are unacceptable and will be addressed in full partnership with CMS,” said Herb Fritch, president of Cigna-HealthSpring, in a statement. “We have internal quality review processes in place that identified some of the areas in advance of the audit findings and we have already started working to remedy them. In other instances, we will implement the changes as quickly as possible to emerge a stronger organization further dedicated to those we serve.” Cigna shares fell 1.2% to $138.52 as of [...]

ICD-10: So Far, So Good

ICD-10 are you in compliance? Five key measurements for monitoring current trends By Mike Denison, senior director, regulatory compliance programs, Change Healthcare Posted on: January 11, 2016 After much planning and anticipation, the October 1, 2015, ICD-10 transition deadline has finally come and gone. Now that the dust is settling, the big question on everyone's mind is: "What impact has it had?" Providers, payers and other stakeholders have spent years working diligently to prepare for the transition to the new code set. While many held their breath in the early weeks of the transition, it appears that the industry can now breathe a collective sigh of relief. Early indicators suggest that the hard work and significant financial investment have paid off as potential issues associated with healthcare transaction processing and payments have been minimal to date. In light of the magnitude of the transition, some providers naturally have experienced a few expected revenue cycle hiccups. These issues should continue to diminish in the coming months, however, as healthcare organizations tweak their systems and identify opportunities for process improvement. The good news is that a review of ICD-9 and ICD-10 claims to date reveals that there is little variance in trends related to average payments and denial rates. Current Trends: A Closer Look Change Healthcare is closely monitoring ICD-10's impact and, thus far, has seen positive trends based on the results of five key measurements, including: 1) Overall ICD-10 use ramp-up compared to forecast; 2) Provider readiness; 3) Clearinghouse and payer rejections; 4) Average payments and denial rates by payer model; and 5) ICD-10 related support caseload. In terms of the forecasted ramp-up rate, the volume of ICD-10 coded claims has trended within 1-2% of [...]

Three ways ICD-10 coding will affect 2016

ICD-10 is here. Are you ready for 2016? by CARL NATALE- DEC 30, 2015 - 06:00 AM This is the time to do a year-in-review post. But the only event worth recapping was the adoption of ICD-10 coding Oct. 1. In the time since, we've constantly noted that there wasn't enough data to know if that was a good thing or not. Regardless, we need to move into 2016 with ICD-10 coding. Here's how it will matter: Big (and small) data will be used We promised that ICD-10 data will lead to a new age in healthcare. Of course that's not going to happen unless healthcare professionals use the data. But data analysis is not easy for everyone to embrace. The value isn't obvious. But if medical practices can associate diagnosis data with revenue, then the business starts looking different. Or if they can see trends in the diagnoses, they could help patients better. Even if you're not believer in data, the federal government and private payers are. They're going to examine your ICD-10 data to find ways to cut their costs. Maybe it's not as simple as cutting reimbursements. But maybe they figure out how to invest money upfront to avoid recurring treatments. Find a way to understand your data instead of accepting what someone else tells you. Electronic health records (EHRs) will need checkups In the first hours of ICD-10 use on Oct. 1, there were complaints about how ICD-10 codes made EHRs too complicated. All of a sudden, there were extra pull down menus. Cheat sheets were complicated. Maybe the problem wasn't the ICD-10 codes. Maybe the problem was the EHRs. IT purchases are hard to get right. Many don't [...]

Keeping up with ICD-10 education

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE ABYSS December 18, 2015 By Avery Hurt Many providers and coders are just getting into the ICD-10 groove, but staying there requires a little bit of ongoing training. For coders this means keeping up their certification. What many coders might not be aware of, however, is that time is running out. Most coders must complete a proficiency test or complete certain continuing education credits by Dec. 31, 2015. Otherwise they will lose their credentialing. Providers need to do a little continuing education as well if they want to stay on top of ICD-10. "Every now and then you need to look to make sure you are using the most specific code," suggested Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians. You don't want to fall into a rut of using the same codes when better ones are available. CMS is going easy on non-specific codes for the first 12 months of ICD-10, but next October will come before you know it. And private payers are expected to start tightening up sooner than that. At the moment, very few claims are being denied on the basis of diagnosis codes, but some experts have started to see a slight uptick in these denials. If you're not already using the most appropriate codes available, make sure you start soon, even if that means an ICD-10 refresher course. Hays said she didn't expect to see much in the way of significant policy changes from payers, but the codes themselves will be adjusted and refined on an ongoing basis. CMS will publish yearly updates to the ICD-10 codes—the flexibility to change as medical science [...]

The Definitive ICD-10 Guide to Holiday Movies

Santa's Healthy Heart! His new ICD-10 coded screening. Written by  Wendy Aiken, PMI-ACP | Monday, 14 December 2015 00:00 We all have one: a beloved holiday flick that inspires us to deck the halls, snuggle up, and press play. Whether you’re a die-hard fan of a Christmas classic, or you prefer the elven shenanigans of Will Ferrell, here’s one holiday treat everyone should enjoy: the coder’s complete ICD-10 list for holiday films. National Lampoon’s Christmas Vacation (1989) Clark Griswold, our favorite overly optimistic father, is no doubt a Christmas movie legend. Despite his high hopes for the perfect family Christmas, he gets more than his fair share of merry misfortune. Blame it on his questionable light-hanging practices, extreme sled-riding, and obsession with that Christmas bonus (for a pool, of course). T75.4XXA Electrocution, initial encounter V00.221A Fall from sled, initial encounter W16.0 Fall into swimming pool It’s a Wonderful Life (1946) After George Bailey, a failing businessman, crashes his car into a tree, he wishes he’d never been born. But a guardian angel shows him that the world would be a grim place if he didn’t exist, and George realizes he really does have a wonderful life. V47 Car occupant injured in collision with fixed or stationary object F33.4 Major depressive disorder, recurrent, in remission R42 Dizziness and giddiness A Christmas Story (1983) Poor Ralphie endures a suspenseful holiday season pining for an official Red Ryder, carbine-action, 200-shot range model BB gun. His friend, meanwhile, learns an ice-covered flagpole can leave you tongue-tied, and Ralphie’s father grieves the loss of his precious leg lamp. W34.118A Accidental malfunction of other gas, air, or spring-operated gun Q38.1 Ankyloglossia (tongue-tied) S82.301A Fracture of lower leg, initial encounter for [...]

NCDs and LCDs Hit Hardest by ICD-10

ICD-10 update from physician practices By Beth Friedman, BSHA, RHIT, president and founder of Agency Ten22 Posted on: December 11, 2015 Despite physician resistance, the transition to ICD-10 has gone relatively smoothly for most physician practices. However, we've also heard the buzz that orthopedic and radiology practices may be facing some challenges related to specificity and medical necessity. Since ICD-10 codes are needed to prove medical necessity in medical group settings, this comes as no surprise to health information and IT professionals. Three coding experts chimed in this week about ICD-10 challenges witnessed at the 60-day mark of ICD-10 implementation. Following is a summary of their experiences to date: Kelly Whittle, MS, principal at ICD-10 Advisory and Whittle Advisors, LLC says confusion and technical glitches with Local Carrier Determinations (LCDs) and National Coverage Determinations (NCDs) are the biggest challenge in physician practices to date. Notably, in mid-November, CMS published a clarification about LCD and NCD updates. Regarding NCD errors, CMS states: "CMS is committed to resolving these small isolated issues quickly to ensure that claims continue to process. Interim solutions are currently in place to permit appropriate and timely claims payment. In most cases, claims inappropriately rejected or denied have been automatically reprocessed and no action is required by the provider." Regarding LCD errors, CMS says: "Once ICD-10 was implemented, some MACs identified LCDs for which they needed to further refine their edits to add allowable ICD-10 diagnosis codes. In general, claims affected by these edits with dates of service on and after October 1, 2015 were suspended until the fixes were implemented. Once the LCD updates were implemented, the MACs released and processed the held claims. Any claims inappropriately denied before the LCD updates [...]

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 in an exclusive interview last September. icd-10-cm coding characters Jorwic caught up once again with 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 [...]