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.


ICD-10: Preventing Medical Necessity Denials

The Firm Services has the latest information regarding ICD-10 and its implementation.  Written by Daria Bonner, CHCA, CCP, RMC | Monday, 23 May 2016 00:00 Given the added specificity inherent in ICD-10, it’s no surprise that medical necessity denials for physician practices and medical groups are expected to increase throughout 2016. In addition to greater levels of code granularity, three key industry drivers are expected to impact ICD-10 coding compliance among physician practices in the year ahead. First, payers will continue to refine coverage policies based on the new code set. Second, the ICD-10 grace period for physician practices comes to a close as of Oct. 1, 2016. And finally, almost 6,000 new ICD-10 codes will be added that same day as the partial code freeze concludes. These factors will impact all providers, but they will be especially notable within physician practices and medical groups. Practices are also predicted to struggle with reporting ICD-10-CM diagnosis codes that aren’t medically necessary as it pertains to supporting the corresponding CPT codes. Without proactive planning, the following three specialties may see an increase in medical necessity denials in the months ahead: Cardiology Pathology/Laboratory Radiology This article takes a closer look at these specialties to identify common medical necessity gaps in physician documentation and clinical coding. Left open, these gaps carry the potential to increase denials, audits, and revenue loss in 2016. Cardiology Concerns With 42 national coverage determinations (NCDs), cardiology is both a high-volume and a high-value service line. While CPT and E&M codes prevail in cardiology claims, the correct assignment of an ICD-10 code drives medical necessity decisions through NCDs. Some cardiology practices are already experiencing medical necessity denials related to the following: Unspecified codes Incomplete codes [...]

Obamacare’s 2017 Insurer Rate Requests Are Starting to Stream in…..

Insurers are dropping out of Obamacare. You have questions? We have answers at The Firm Services. It's been more than two years since the Affordable Care Act, which you probably know better as Obamacare, went into full effect for individual consumers, and in that time the new health law has enrolled about 12.7 million people. Note that this doesn't take into account the millions of Americans who've been able to get health insurance through the expansion of Medicaid and CHIP within their respective states. In total, 31 states chose to accept federal money and expand their Medicaid program to provide healthcare to low-income individuals and families. On the surface, Obamacare has led to a statistically meaningful reduction in the number of people who are uninsured. Gallup's most recent survey in the first quarter pegged the uninsured rate at 11%, which is down 90 basis points from the fourth quarter, and is 6.1% lower than Q4 2013, the quarter prior to the full implementation of Obamacare. The program has presumably opened the door for millions of lower-income Americans and those with pre-existing health conditions to get the medical care they need. But Obamacare has also opened the door to another set of problems that question its ongoing survival. An Obamacare exodus For instance, UnitedHealth Group (NYSE: UNH), the largest insurer in the U.S., recently announced that it would be vacating a majority of the 34 states it's currently operating in beginning in 2017. The reason? Higher member utilization rates and the ease with which consumers can change health plans are set to cause UnitedHealth to lose around $500 million on its Obamacare individual marketplace plans in 2016. Mind you, we're talking about the largest [...]

ICD-10 Increases in Claims Denials-Where denials are likely to hit medical practices.

ICD-10 LET THE FIRM SERVICES BOOST YOU OVER THE OBSTACLES CARL NATALE MAY 17, 2016 - 08:04 PM for ICD 10 Watch Healthcare providers should be getting ready for an increase in claim denials. It was mentioned earlier this week that healthcare payers may be simply gathering ICD-10 data they can use identify problems later — like after Oct. 1. This data could drive denial decisions. Speaking of data. If healthcare payers are going to be using data to find problems in medical practices, shouldn't medical practices start looking at data to find those problems first? That's what Debi Primeau did in her For the Record analysis of eight potential denial targets: Sequencing: Review the ICD-10-CM guidelines to make sure right ICD-10 codes are chosen for the primary diagnosis. Aftercare: The Z codes designate specific instances of aftercare. But usually it is correct to use the injury ICD-10 code with the seventh character designating a subsequent encounter. Seventh character:Speaking of subsequent encounters. It doesn't mean what many healthcare professionals think it does when they're trying to be clever. Unspecified codes:Yes, they do exist. But will auditors start looking for them? Laterality: It's great that ICD-10 codes allow to differentiate between the left and right sides of the body. But sometimes one bilateral code is needed instead of two diagnosis codes to designate the left and right side as affected. Hip and knee replacements: Use ICD-10-PCS codes for removal and replacement. Missing codes: This may get some physician push back. But the guidelines require supporting diagnoses in some cases. Medical necessity: This is going to require keeping up with local coverage determination (LCD) and national coverage determination (NCD) updates. If ICD-10 denials haven't been a problem, that doesn't [...]

By |May 20th, 2016|Commercial Insurance, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare|Comments Off on ICD-10 Increases in Claims Denials-Where denials are likely to hit medical practices.

Federal judge strikes down Obamacare payments

Richard Wolf, Gregory Korte and Jayne O'Donnell, USA TODAY 6:02 p.m. EDT May 12, 2016 WASHINGTON — Republicans won the first round Thursday in a separation of powers battle against President Obama that once again focuses on his most prized achievement: Obamacare. Federal district Judge Rosemary Collyer, a Republican appointee, ruled that the law did not provide for the funds insurers need to make health insurance policies under the program affordable. While the law provides for tax credits, she said, it does not authorize an appropriation for slashing deductibles and copayments. Without those reductions from insurers, many consumers could not afford to buy insurance. "Congress authorized reduced cost-sharing but did not appropriate monies for it,," Collyer said in her 38-page ruling. "Congress is the only source for such an appropriation, and no public money can be spent without one." Collyer blocked her own decision from taking effect while awaiting a likely appeal from the administration. Cost-sharing subsidies reduce consumers' insurance payments — an important feature of the Affordable Care Act, because deductibles are rising. Under the law, subsidies are available to people who earn between 100% and 400% of the federal poverty level, with extra assistance available for those up to 250%. For a family of four, that’s about $24,000 to $61,000. The Commonwealth Fund estimated up to 7 million people might have plans with cost-sharing reductions this year. The ruling does not represent as big a threat to the health care law as two previous conservative challenges swatted down by the Supreme Court in 2012 and 2015. The first would have gutted the law; the second would have eliminated tax credits in many states. “It’s a setback, and it’s a distraction … but a [...]

Physicians Credentialing avoid these common mistakes. Let The Firm Credentialing experts help you.

Credentialing? Let the experts at The Firm Services complete it for you. Provider credentialing and enrollment is an absolute necessity when running a successful physician practice. Becoming a provider with commercial and government insurance companies allows you to maintain steady patient referrals and cash flow which is the backbone of any successful practice. Avoiding these credentialing mistakes will ensure your credentialing and enrollment process moves along efficiently and effectively. Here are the top 4 commonly made mistakes. 1. Incomplete Information The most common mistake associated with credentialing is a lack of attention to detail. Application errors lead to delays and potentially denials. A typical credentialing application will ask for practice address, phone, fax, contact information, services provided, copies of your licensure, employment history, average patient profile and any records of past legal troubles regarding your medical practice. Omitting or making mistakes on any of this data can lead to delays in your provider credentialing, and it can sometimes be grounds for a denial. The solution? All your provider applications should go through a rigorous review process to certify accuracy before it is submitted to committee. Getting it right the first time means you'll get a new provider credentialed faster. 2. Lack of Follow-Up Many plans are backlogged with credentialing applications. Make every effort to confirm your application was received and where in the process it is. If something sounds like it does not make sense, question the response. We often hear “I have no record of the application” and when presented with evidence of receipt via a trackable transit confirmation, the answer changes to “Oh, it is on my desk." Make sure you understand the answer before you accept it. Follow-up at regular [...]

By |May 9th, 2016|Blog, Commercial Insurance, Credentialing, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Compliance, Medical Credentialing, Medicare, medicare claims, Physician Credentialing|Comments Off on Physicians Credentialing avoid these common mistakes. Let The Firm Credentialing experts help you.

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 [...]