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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.


Medicaid estimate renews cost concerns over Obamacare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services Tribune news services Contact Reporter- August 12,2016 - 8:55 am The cost of expanding Medicaid to millions more low-income people is increasing faster than expected, the government says, raising questions about a vital part of President Barack Obama's health care law. The law called for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year. Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things. In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated. "We were told all along that the expansion population would be less costly," said health economist Brian Blase with the Mercatus Center at George Mason University in Virginia. "They are turning out to be far more expensive." Blase previously served as a GOP congressional aide. The new estimates could be a warning light for Democrat Hillary Clinton, who has promised that if elected president she would work to expand Medicaid in the remaining 19 states that have not done so. Higher costs would make it harder for a President Clinton to sell Obama's full-financing plan to Congress. Under the law, people making up to 138 percent of the federal poverty line — roughly $16,390 for an individual and $33,530 for a family of four — are eligible for Medicaid at little or no cost to them. An estimated 9 million to [...]

Who’s Gaming Obamacare? Better to Ask: Who Isn’t?

Need answers? Contact the experts at The Firm Services. Bloomberg View-AUG 8, 2016 4:44 PM EDT By Megan McArdle Last week, I outlined eight possible futures for Obamacare. By curious coincidence, few of them looked like the paradise of lower premiums and better care that the law’s supporters had promised. In the best case scenarios, they looked more like what critics had warned about -- "Medicaid for all," or fiscal disaster, or a slow-motion implosion of much of the market for private insurance as premiums soared and healthy middle-class people dropped out. What I did not explore was why we seem to have come to this pass -- which is to say, why insurers seem suddenly so leery of the exchanges and why premiums are going up so much for Obamacare policies. No one really seems to know exactly why insurers are having so much trouble in the exchanges. Insurers may know, but they have generally issued vague statements about “worse than expected experience.” The closest we’ve gotten to an assessment was a statement from a big insurer last year to the effect that people who were signing up outside of the normal enrollment period seemed to have higher-than-expected bills, while paying fewer than expected premiums. Which tells us something, but doesn’t necessarily explain double-digit premium increases. This weekend brought a new suggestion across my desk. At Forbes, Bruce Japsen writes that insurers think providers are funding nonprofits to pay Obamacare premiums for high-cost Medicaid patients, thus sticking insurers with a lot of big bills for a lot of very sick patients. Why would they do this, you may be asking yourself? Because Medicaid reimbursements are extremely low. If you have a patient who is [...]

Anthem links Obamacare expansion with approval of Cigna acquisition

Politico- By PAUL DEMKO 07/28/16 02:15 PM EDT Anthem on Wednesday fought back against an Obama administration antitrust lawsuit by conditioning its expansion in the struggling Obamacare market to approval of its acquisition of Cigna. The company plans to add nine states to its Obamacare participation if the deal goes through, company officials said on a call with investors. The DOJ last week sued to block Anthem's proposed $54 billion acquisition of Cigna, citing concerns about harm to competition, and also filed suit against Aetna's planned $37 billion takeover of Humana. If successful the mergers would reduce the number of major national carriers from five to three. Anthem CEO Joe Swedish indicated that the company remains committed to the Obamacare exchanges despite the "many and continuing challenges" of the fledgling marketplaces. The company had 923,000 exchange customers in 14 states at the end of the second quarter of this year. "Our acquisition of Cigna will help stabilize pricing in this volatile market, enabling Anthem to continue its commitment to the public exchanges," Swedish said. Two other major national carriers have announced significant pullbacks from the exchange markets because of losses. UnitedHealth Group is pulling out of most of the 34 states where it currently competes. Humana is leaving eight of the 19 states where it sells products in the individual market. A trial on the Cigna deal should start in federal court in Washington, D.C., in October and take roughly four months, Anthem officials said. "Obviously we’re going to run out the litigation as long as it takes," Swedish said. Questions about commercial insurance reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services [...]

ObamaCare and Big Insurance

The Justice Department tries to block the mergers that Obama’s health law intended. Wall Street Journal- July 24, 2016 6:15 p.m. ET Politicians tend to be most enraged by the problems they cause, and the liberal fury against insurance mergers is a classic of the genre. ObamaCare was designed to create government-directed oligopolies, but now its authors claim to be alarmed by less competition. Last week federal and 11 state antitrust regulators filed a double lawsuit to block the pending $54 billion insurance tie-up between Anthem and Cigna and the $37 billion acquisition of Humana by Aetna. The mergers would reduce the national commercial insurers to three from five, and Attorney General Loretta Lynch says the government won’t cede such “tremendous power” over health care to a more concentrated industry. Has she checked with the White House? The logic of ObamaCare is that larger and more integrated conglomerates are superior to a market with many insurers, doctors and hospitals vying for consumer business. The law promotes corporatism on the theory that larger systems are more efficient, but also because giants are easier to control politically and will standardize care as ordered. The new regulations and mandates since the law passed in 2010 are designed to encourage consolidation, from accountable care organizations to new reimbursement methods and much else. The rise of huge health systems, salaried physicians and mega-insurers is precisely what Peter Orszag and Jonathan Gruber wanted. But now the trust busters are fretting that these giants will have less incentive to innovate to reduce costs and improve quality, and patients will have fewer choices. Well, yes—as critics predicted. “Competitive insurance markets are essential to providing Americans the affordable and high-quality health-care they deserve,” Ms. [...]

Calling Cadillac Tax A Lemon, Congress Moves To Repeal Core Of Obamacare

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services JUL 15, 2016 @ 09:08 AM - Forbes -Robert Wood More than 300 members of the House support legislation to repeal the Cadillac tax. The Cadillac tax is a 40% tax on the cost of employer-sponsored health coverage exceeding certain thresholds. Those ‘Cadillac’ thresholds are actually more Yugo territory: $10,800 for self-only coverage, and $29,100 for family coverage. What’s more, the cost of wellness programs, on-site clinics and other plan features meant to reduce expenses are also included. The result is that vast number of participants in numerous employer-sponsored plans will be affected. There are two bills in the House, H.R. 879 introduced by Rep. Frank Guinta (R-NH), and H.R. 2050, introduced by Rep. Joe Courtney (D-CT). The House and Senate may actually do it this time. Those favoring repeal come from all corners. But a major advocate for repeal is the Alliance to Fight the 40, a coalition of public and private employers, patient advocates, businesses, unions, and more. And they are racking up the votes and sponsors. The Supreme Court upheld Obamacare as a tax law, and it contains many taxes, including the Cadillac tax. It is a whopping 40% on top of all other federal taxes. It had a clever delayed effective date that was supposed to make it easier for all of us to swallow. Obamacare was passed in 2010, but the Cadillac tax was deferred until 2018. Later, Congress rolled it back two more years, to 2020. That delayed effective date clearly de-emphasized the importance of the provision. But when it does hit, it will hit with a vengeance. It was supposed to target overly generous employer-provided health care plans. That doesn’t just mean for executives. In fact, the tax mostly appears to hit union [...]

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 - 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

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 [...]