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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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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.

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 [...]

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 [...]

CMS Announces New ICD-10 Resources, Unveils July Testing Results

Medicare ICD-10 Questions? We have answers at The Firm Services. On Thursday, CMS Acting Administrator Andy Slavitt offered further details about resources the agency will have in place to help providers with the upcoming switchover to ICD-10 code sets, Health Data Management reports (Slabodkin [1], Health Data Management, 8/28). U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and procedures. Background On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians' transition. Among other things, CMS said it would: Appoint an ICD-10 ombudsman to help oversee the transition; Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes; Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and Provide a range of online resources -- including Web conferences and training documents -- to aid providers in the transition. The measures do not signify an ICD-10 delay (iHealthBeat, 7/29). Latest Updates During a national provider call, Slavitt said CMS has created and is staffing an ICD-10 Coordination Center, which will open at the end of September. It will "be responsible for managing and triaging issues and ensuring timely communications" with providers, Slavitt said. In addition, Slavitt announced that William Rogers, a practicing emergency department physician and director of CMS' Physicians Regulatory Issues Team, will serve as ICD-10 ombudsman. He will assess and respond to stakeholder concerns with the transition. Rogers has been an ombudsman for clinicians who work with Medicare [...]

Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors

Firm Services provides Physician Credentialing and Revalidation Thousands of doctors who bill Medicare used questionable addresses, GAO report finds By CHRISTOPHER WEAVER :Updated July 21, 2015 8:09 p.m. ET Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program. Medicare records listed doctors and other providers as practicing at invalid addresses, such as commercial mailbox stores, construction sites and, in one case, a fast-food restaurant, according to a report by the Government Accountability Office that examined data through March 2013. Over the past five years, the federal Centers for Medicare and Medicaid Services, which runs Medicare, has been revamping its enrollment system and verifying provider information, such as addresses and licensure. The overhaul is partly due to requirements of the 2010 Affordable Care Act. The CMS said Tuesday that as a result of its enhanced screening efforts, it has kicked more than 34,000 providers out of the program since February 2011. The GAO says that some screening problems persist, however, among the 1.8 million providers enrolled to bill Medicare from nearly a million addresses. The report estimated that about 23,400 addresses might be invalid. The 2.3% of provider addresses the GAO estimated might be invalid could be the results of data-entry errors, according to written responses to the GAO by Jim Esquea, the assistant secretary for legislation for the federal Department of Health and Human Services. CMS said some provider locations flagged in the GAO report didn’t turn out to be fraudulent. For instance, the provider who listed the fast-food location had a valid medical office elsewhere and [...]

CMS Releases FAQs To Clarify Plan To Ease ICD-10 Transition

ICD-10 is coming October 1st. Are you ready? Wednesday, July 29, 2015 On Monday, CMS released answers to frequently asked questions to help clarify recently announced measures that aim to provide physicians with some flexibility as they transition to the new ICD-10 code sets, EHR Intelligence reports. Background U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.  On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians' transition. Among other things, CMS said it would: Appoint an ICD-10 ombudsman to help oversee the transition; Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes; Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and Provide a range of online resources -- including Web conferences and training documents -- to aid providers in the transition. FAQ Details CMS posted a list of 13 FAQs to clarify several aspects of the measures. For example, the agency noted that: The ICD-10 ombudsman will be in place by Oct. 1; The measures do not signify an ICD-10 delay; Submitters whose claims are denied will be notified with an explanation of the rejection; Submitters should follow existing processes for correcting and resubmitting rejected claims (Goedert, Health Data Management, 7/28); The measures only apply to Medicare fee-for-service claims; The guidance does not apply to Medicaid claims, but each state will be "required to process submitted claims that include ICD-10 codes for services furnished [...]

CMS Announced Proposed Rule on the FY16 Medicare Physician Fee Schedule

Credentialing, Revalidation Services professionals at The Firm Services In a press release issued on July 8, the Centers for Medicare and Medicaid Services (CMS) announced its Proposed Rule on the FY16 Medicare Physician Fee Schedule (PFS). This Proposed Rule represents the first update to the PFS since the repeal of the Sustainable Growth Rate (SGR) update methodology earlier this year. Andy Slavitt Administrator of CMS stated “CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care. Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people.”The proposed CY 2016 PFS rule includes but is not limited to the following updates: Payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes Physician Quality Reporting System Physician Value-Based Payment Modifier CMS is requesting comments by Aug. 31, 2015 on the following: Implementation of certain provisions of the MACRA, including  the new Merit-based Incentive payment system Potential expansion of the Comprehensive Primary Care Initiative The Proposed Rule was published today in the Federal Register and can be accessed by clicking here. Questions about 2016 Medicare Fee Schedules or ICD -10 ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or credentialing@thefirmservices.com 

How Doctors can really cut costs for medicare patients.

The best use of Medicare Oversight? Follow the Real Money Physicians are eyeing the wrong procedures in the quest to cut costs for Medicare patients. By Mark Pauly May 15, 2015 | 4:15 p.m. EDT Physicians have, of late, played an amazingly small role in guiding health policy. They had little to say or do with health insurance reform, which was the major focus of the Affordable Care Act. But to some extent, they have been trying to get on the right side of history by expressing concern about growing medical care spending and identifying services they control or sell that might be eliminated. The "Choosing Wisely" campaign, for example, has recruited physician specialty societies to compile lists of medical treatments that they were formerly choosing unwisely. No one could question efforts to deter care that is harmful or a waste of time. But if physicians expect to enlist consumers and insurers in this campaign, it would help if doctors were doing more than criticizing what other doctors do. It would help if their criticism was based on evidence of actual patterns of care observed in large data sets and if the reasons for such criticism could be well-identified. It would also help if changing the practices they criticize might lead to saving some serious money. The most recent example of physician efforts to document low-value care is a study reported last month in the New England Journal of Medicine, titled "Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery." Cataract surgery, to replace a clouded lens in the eye, is the most common elective surgical procedure for elderly people; it is a safe and effective way to improve vision and is usually performed by an [...]

Supreme Court saves Obamacare

Physicians Credentialing Services By Ariane de Vogue and Jeremy Diamond, CNN Washington (CNN) Obamacare has survived -- again. In a 6-3 decision, the Supreme Court saved the controversial health care law that will define President Barack Obama's administration for generations to come. The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage. "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all," Obama said from the White House. "The Affordable Care Act is here to stay" In a moment of high drama, Chief Justice John Roberts sent a bolt of tension through the Court when he soberly announced that he would issue the majority opinion in the case. About two-thirds of the way through his reading, it became clear that he again would be responsible for rescuing Obamacare. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter." READ: John Roberts' big moment: Will he anger conservatives again? He was joined by Justice Anthony Kennedy -- who is often the Court's swing vote -- and the four liberal justices. Justice Antonin Scalia wrote [...]

HHS Inspector General Issues Physician Compensation Medicare Fraud Alert

Physicians Credentialing Doctors for Medicare HHS Inspector General Issues Physician Compensation Medicare Fraud Alert posted on: Wednesday, June 17, 2015 The Office of the Inspector General of the Department of Health and Human Services (“OIG”) issued a warning earlier this month to physicians. The OIG enforces healthcare laws including the Stark Law and Anti-Kickback statute. Federal law prohibits hospitals from offering anything of value in exchange for certain healthcare business. Physicians can be paid for their services but not for sending Medicare patients to hospitals. In recent years, there have been many prosecutions of hospitals for violating anti-kickback rules. Long gone are the days when a hospital would reward doctors bringing in patients with a cash bonus. Now, the “kickbacks” or bribes are more concealed. Compensation agreements between hospitals and doctors are always scrutinized carefully. On June 9th, the OIG issued a written fraud alert to warn hospitals and doctors of new schemes that they see as problematic. This is only the fourth time in five years that the OIG issued a written fraud alert. According to the Department of Health and Human Services, doctors who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for services actually provided. Even if a compensation package is otherwise legal, it can still violate the law if just one of its purposes is designed to compensate the physician for bringing in Medicaid or Medicare patients. The written guidance specifically addresses “medical directorship” arrangements.  The OIG believes some doctors are being given titles and extra pay simply because they bring in more patients. To avoid violating the law, a doctor offered a directorship must actually perform the duties of [...]