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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.


President Floats Obamacare Fixes and Offers to Let GOP Rename It

NBC NEWS by JON SCHUPPE-OCT 20 2016, 5:10 PM ET President Obama on Thursday proposed a new round of tax credits and a government-run insurance plan for his healthcare reform program, fixes he said would correct jumps in some insurance premiums and the lackluster recruitment of young, healthy people. Obama delivered his message in Florida, singling out Gov. Rick Scott for his refusal to participate in Obamacare's offer to expand Medicaid coverage for poor people. If he and the governors of 18 other states took part, four million more people would be able to afford insurance, Obama said. Those corrections, he told an audience at Miami Dade College, would bring Obamacare much closer to reducing the number of uninsured Americans — a figure that currently stands at about 29 million people. He said he welcomed additional ideas from his Republican opponents in Congress, even if they wanted to rechristen it. "They can even change the name of the law to Reagancare," Obama said, drawing laughs from the crowd. "Or they can call it Paul Ryancare," Obama added, referring to the speaker of the U.S. House of Representatives. "I don't care — about credit. I just want it to work." As a prelude to his proposed solutions, Obama spent half of his 40-minute speech touting the Affordable Care Act, which many Republicans, including presidential candidate Donald Trump, have vowed to repeal. He pointed out that about 20 million more Americans have signed up for insurance since the program began offering state-based marketplaces and expanded Medicaid four years ago, bringing the uninsured rate to its lowest number in decades. But there have been many well publicized stumbles, including broken websites and dramatic increases in premiums, not to [...]

Obamacare Enrollment to See ‘Significant Slowdown’ Next Year

by Katherine Doherty Bloomberg News October 13, 2016 — 7:05 AM PDT Updated on October 13, 2016 — 8:55 AM PDT Enrollment in the Obamacare insurance marketplace is likely to stall or even decline for 2017 as higher premiums drive away people who aren’t eligible for government subsidies, according to S&P Global Ratings forecasts. “Our forecasted modest-to-negative growth is clearly a bump in the road, but doesn’t signal ‘game-over’ for the marketplace,” S&P analyst Deep Banerjee wrote in a report released Thursday. This November will be the fourth open enrollment period for individuals to choose insurance plans under the Affordable Care Act, President Barack Obama’s signature health-care law. The “significant slowdown” predicted by S&P would be another setback for ACA’s government-run insurance markets, after big insurers pulled out of many states because of mounting losses. ACA enrollment will range from 10.2 million to 11.6 million people after 2017’s enrollment season, which starts Nov. 1, S&P said. The lower end of the forecast range implies a decline of 8 percent compared with 2016 and the higher end a 4 percent gain. With premiums set to rise an average of 25 percent across the marketplace, according to data from, some current enrollees who aren’t eligible for tax credits may not re-enroll in 2017. Still, a moderation in premium increases beyond 2017 will likely bring growth back to the marketplace, according to S&P. “2017 will not be the year that expansion happens, however a flat year-over-year, or a slight decline should not be mistaken as game over,” analyst Banerjee said in an interview. Banerjee described next year as one step back and one step forward for the ACA. He expects lapses among people who don’t get subsidies, [...]

ObamaCare’s Meltdown Has Arrived

The Wall Street Journal-  By ANDREW OGLES and LUKE HILGEMANN Updated Oct. 6, 2016 12:50 p.m. ET With insurers pulling back, half of Tennesseans covered under the plan are losing their coverage. Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said. Then last week BlueCross BlueShield of Tennessee announced it would leave three of the state’s largest exchange markets—Nashville, Memphis and Knoxville. “We have experienced losses approaching $500 million over the course of three years on ACA plans,” the company said, “which is unsustainable.” As a result, more than 100,000 Tennesseans will be forced to seek out new coverage for 2017. BlueCross is only the latest insurer to head for the exits. Community Health Alliance, the insurance co-op established under ObamaCare, is winding down due to financial failure, leaving 30,000 people without coverage. UnitedHealthcare said in April it is departing Tennessee’s exchange after significant losses. That’s another 41,000 people needing new plans. All told, more than 60% of our state’s ObamaCare consumers will lose their coverage heading into 2017. When they go in search of a replacement plan, they will confront two unfortunate realities: a dearth of options and skyrocketing costs. Seventy-three out of Tennessee’s 95 counties will have only one insurer on the exchange, meaning no meaningful competition whatsoever. In regions where BlueCross BlueShield is pulling out, there will be two remaining major carriers, Cigna and Humana. The only large metro area with more options will be Chattanooga. Then there [...]

Experimental Obamacare health plan exits Chicago and Atlanta markets

CNBC -Dan Mangan | @_DanMangan September 30,2016 This Obamacare experiment is a flop. Harken Health — billed as an "innovative" health insurer and started by America's biggest insurance company to appeal to Obamacare customers — will exit the only two government-run exchange markets where it was selling coverage after reportedly booking losses of about $70 million in the first half of this year. The UnitedHealth Group unit — which offers unlimited primary care visits at no out-of-pocket cost to customers who use Harken Health clinics — will reportedly continue selling plans outside of Obamacare exchanges in the individual and employer markets of both Chicago and Atlanta next year. But its departure in 2017 from the Obamacare exchanges that serve those cities represents another setback for advocates of the Affordable Care Act and their efforts to offer individual health plan customers a broad range of affordable coverage options. Harken in August said it was abandoning plans to sell Obamacare exchange coverage in Miami and Fort Lauderdale, Florida, next year. And Harken's parent, UnitedHealth, earlier this year said it would itself exit most Obamacare exchanges, including the federal marketplace that services Illinois, in 2017. The Chicago Tribune noted that because of Harken's exit, residents of Cook County, which includes Chicago, will have just three insurers to choose from if they want to buy coverage on, the federal Obamacare exchange that serves Illinois and 37 other states. and state-run Obamacare exchanges are the only places that low- and moderate-income customers receive subsidies, in the form of federal tax credits, to lower the cost of their monthly premiums. The subsidies, whose amounts are linked to income levels and the premium charges, can significantly reduce the cost of [...]

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 

Obama steps in to save Obamacare

With no lifeline coming from the divided Congress, the administration is redoubling pleas for insurers to shore up the federal health care law. Politico By Paul Demko 09/16/16 05:22 AM EDT Deep into the final year of his presidency, Barack Obama is working behind the scenes to secure Obamacare’s legacy, struggling to bolster a program whose ultimate success or failure will likely be determined by his successor. With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage. The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options. On Monday, Obama met face to face at the White House with leading insurance executives, asking for their continued commitment to the health law despite its recent spate of difficulties. Insurers have come to the White House periodically as the law has rolled out; this time the president made a direct plea for their ongoing support. They in turn pressed their case for steps the administration can still take to strengthen the Obamacare markets. Notably absent were two of the national insurers that have already bailed on most Obamacare marketplaces — Aetna and UnitedHealth Group. “We know that this progress has not been without challenges,” Obama wrote this week to each insurer selling Obamacare plans. “Most new enterprises have growing pains and opportunities for improvement. The Marketplace, while strong, is no exception. Time and experience will help drive that improvement, as will constructive policy changes.” Meanwhile, the administration [...]

Dems use ObamaCare crisis to revive ‘public option’ push

By Barnini Chakraborty Published September 07, 2016 President Obama and his Democratic allies are seizing on the exodus of private insurers from ObamaCare markets to renew their push for a so-called "public option" -- but Republicans say more "government intervention" is not the answer to the latest Affordable Care Act woes. A public option -- or insurance plan offered by the government -- had been written into early versions of the bill but failed to make the final cut in the law signed by Obama in March 2010. But with many states seeing private insurers exit ObamaCare markets amid concerns over cost and other factors, Democrats see a silver lining to what critics are calling another ObamaCare crisis -- a reason to bring the option back. “Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited,” Obama wrote last month in the Journal of the American Medical Association. The president called on his White House successor and Congress to implement the option. A former Obama health official, Ezekiel Emanuel, also backed up the president in a recent op-ed. And ex-Obama campaign manager David Plouffe added his support in an interview with NBC's "Meet the Press." If elected, Democratic presidential nominee Hillary Clinton says she’ll look for ways to improve ObamaCare, which includes supporting a public option. Her Republican rival Donald Trump and several GOP lawmakers, though, say the public option isn’t an option at all. Sen. John McCain, R-Ariz., who is seeking a 6th term, has been a vocal opponent of ObamaCare from the start and maintains “the whole thing is collapsing like a house [...]

The government just announced some big changes to try to fix Obamacare

Business Insider-Bob Bryan -August 29,2016 The government is offering some ideas to try to fix the Affordable Care Act, the healthcare law known as Obamacare, amid a series of missteps that have befallen President Barack Obama's signature legislative achievement. With Obamacare having being dogged by negative news over the past few weeks — as major insurers have pulled out of some public exchanges and regulators have said the exchanges are "near collapse" — the US Centers for Medicare and Medicaid Services, or CMS, proposed a series of changes on Monday to try to correct some of the exchange issues. CMS, the division of the US Department of Health and Human Services that oversees the exchanges, proposed tweaks that would make it less risky for insurers in the marketplace to take on sick patients. Two of the biggest problems for the exchanges have been a lack of young people, who help offset higher-cost patients, signing up for insurance and generally sicker-than-expected people getting coverage through the exchanges, leading to huge losses for some insurers. A few of the 14 total proposals include: Using some of the fees from the federally funded marketplace for outreach to get more young people to sign up. Strengthening rules for signing up for insurance outside the open-enrollment period to ensure that people are not waiting until they are sick to get coverage. Take prescription-drug use into account when evaluating the risk profile of potential patients. Previously, this had not been taken into account, and insurers argued that it prevented them from getting a full picture of possible patients' health status. Creating more flexibility for insurers in their bronze plan offerings to reduce cost burdens. Kevin Counihan, the insurance marketplace CEO at [...]

Choices dwindling for Obamacare customers

Let the Experts at The Firm Services assist your medical practice. CNN Money by Tami Luhby @Luhby August 23, 2016: 7:53 AM ET Many consumers may find they have few choices when shopping on the Obamacare exchanges for 2017. Industry giants Aetna (AET), UnitedHealthcare (UNH) and Humana (HUM) are scaling back their presences on the exchanges. And smaller insurers, including more than a dozen co-ops funded by the federal government to foster competition, have gone out of business or are dropping out of the program. Nearly 36% of markets may have only one insurer participating on the exchanges, up from 4% this year, according to an analysis by Avalere Health, a consulting company. And nearly 55% may have two or fewer choices, up from 33% in 2016. Most affected by the upheaval in the Obamacare markets are the residents of Pinal County, Arizona. This rural county outside of Phoenix has the dubious distinction of being the first place without any options since the exchanges opened in 2014. Federal and state regulators must now scramble to deal with this unprecedented situation. Some of these markets are relatively small and rural. Still, about 17% of eligible consumers will have only one carrier in their exchange when open enrollment begins in November, according to the McKinsey Center for U.S. Health System Reform. That's up from 2% this year. A healthy insurance market has at least three carriers, said Dan Mendelson, Avalere's president. "You want competitive markets," he said. "Rates are lowest when there is actual competition in a marketplace. Competition will be non-existent in five entire states. Only one insurer will serve Alabama, Alaska, Oklahoma, South Carolina and Wyoming, according to a recent tally by the [...]

Aetna to cut back 70% on Obamacare plans in 2017

Have questions about Obamacare and Aetna ?Call us we can help. Aetna is sharply cutting its participation in Obamacare exchanges for 2017. The health insurer said it will offer individual Affordable Care Act exchange plans in just four states, down from 15 this year, in an effort to reduce its losses. "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision," Chairman and CEO Marc Bertolini said in a statement. The insurance giant says it will offer ACA exchange plans in Delaware, Iowa, Nebraska and Virginia, slashing its Obamacare footprint by 70 percent next year. It will offer ACA plans in just 242 counties nationally, down from nearly 780 this year. Aetna's announcement comes two weeks after the company booked $200 million in ACA-related pretax losses in its Q2 earnings report and nearly one month after the Department of Justice's antitrust division sued to block the health insurer's acquisition of rival Humana. Humana has also announced it will sharply cut back from the exchanges. Its pullback, in the wake of UnitedHealth's departure from all but a handful of exchanges, means that hundreds of thousands of Obamacare plan members will no longer have access to plans from the nation's three major insurers in 2017. Aetna has been one of the largest Obamacare players since the launch of the exchanges two years ago, offering plans in more than two dozen states. The Obama administration's chief executive of the federal marketplace attributed the insurer's departure to the forces of competition in an evolving insurance market. "Aetna's decision to alter its Marketplace participation does not change the fundamental fact that the Health Insurance [...]