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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.


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 

Emergency cash a must for ICD-10

ICD-10 is coming October 1st. Are you ready? Extra funds can go a long way to relieving anticipated headaches of code change Healthcare providers may face disruptions in their payments even if they are on target to operate using ICD-10 codes on Oct. 1, 2014. Since providers will, and indeed need, to be able to pay rent and staff salaries if the transition does not flow as smoothly as testing has indicated, experts advise having up to several months' cash reserves or access to cash through a loan or line of credit to avoid potential headaches. "Just figure that with the transition to ICD-10 there will be delays in reimbursement," said April Arzate, vice president of client services at MediGain, a Dallas-based revenue cycle and healthcare analytics company. Although there will be a great deal of testing and preparation done by the vendors of practice management and electronic health record (EHR) systems by clearinghouses and payers, "we really won't know the true effect until they turn it on," Arzate added. Mitigate revenue disruption The recommendation that Arzate pointed to is to reserve at least enough money to cover medical supplies, payroll, rent, everything required to keep the practice operational for three to six months — just in case any payers experience disruptions in cash flow that delay payments. That's especially difficult for small practices. "You may not have to have it on hand," Arzate explained, "but you need to have the resources available." It's better to talk with the bank now before the funds are needed, added Clint Hughes, MediGain vice president of marketing. "The bank will be more open now than if you come to them desperate because you're two months behind," he said. Arzate suggested that they establish [...]

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

Medicare ICD-10 Questions? We have answers at The Firm Services July 6,2015 CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” “ICD 10 [...]

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 [...]

CMS Releases Medicare Cost Data on Physicians. Now What?

Credentialing, Revalidation Services professionals at The Firm Services Jacqueline Fellows, for HealthLeaders Media , June 4, 2015 Data limitations don't give an accurate picture of what Medicare reimbursement really means for physicians. But patients are increasingly aware of healthcare costs, and physicians should not shy away from a conversation. The report released this week by the Centers for Medicare and Medicaid Services detailing that over 950,000 providers were paid $90 billion for medical services they provided to Medicare beneficiaries in 2013 has spawned sensational headlines about Medicare's millionaire doctors. The headlines aren't wrong, but it's a small group of physicians that are garnering the attention of many. To prevent an inaccurate narrative, doctors may need to prepare for patients' questions. This is the second time CMS has released physician-specific data for Medicare payments in an effort be more transparent. In a prepared statement, American Medical Association President Robert Wah, MD, commended CMS for its effort, but criticized the agency for giving so little context to what the data means for patients. "Specifically, the data released today do not provide actionable information on the quality of care that patients and physicians can use to make any meaningful conclusions … [or] enough context to prevent the types of inaccuracies, misinterpretations, and false assertions that occurred the last time the administration released Medicare Part B claims data." It's true that the data has many limitations. For one, there is no information that gauges quality. It also shows information only on Medicare services. Depending on the payer mix of a physician office, Medicare beneficiaries could be a minority or majority. Geographic variation in payment amounts isn't accounted for. Despite the criticism and the limits of the data, [...]

2015 Medicare Changes, How does it affect your practice?

Physicians Credentialing Doctors for Medicare 2015 Medicare Changes From APTA - May 21,2015 Scroll down this page for info on topics including the Medicare fee schedule and therapy cap, SGR, PQRS, functional limitation reporting, and more. New Year, New Changes Following years of advocacy by physicians, physical therapists, and other health care professionals, Congress passed a bill to repeal the flawed SGR formula on April 14, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 came a little more than a year after President Obama, on April 1, 2014, signed into law the Protecting Access to Medicare Act of 2014, the last in a long line of annual temporary "fixes" that prevented a large payment cut for physicians, physical therapists, and other health care professionals from taking effect. The 2014 law also extended the therapy cap exceptions process until March 31, 2015, and the April 14, 2015, repeal law further extends the exceptions process to December 31, 2017. In addition, a number of changes included in the 2015 Medicare Physician Fee Schedule final rule affect physical therapist practice and payment for 2015. Changes that are in effect regarding fee schedule payment rates include the following: From January 1-June 30, 2015, there is a slight change from 2014 in the conversion factor for providers. The 2015 conversion factor for the first 6 months is $35.7547 as mandated by legislation. (The 2014 conversion factor was $35.8228.) Effective July 1, 2015, there will be a .5% update to the payment rates for the remainder of the year and an extension of the existing 1.0 geographic practice cost index (GPCI) work floor. Changes in effect regarding the therapy cap include the following: The therapy cap amount [...]

By |May 28th, 2015|Commercial Insurance, Healthcare Professionals, Medicaid, Medical Billing, Medical Credentialing, Medical Insurance, Medicare|Comments Off on 2015 Medicare Changes, How does it affect your practice?

Grassley to Justice Department: Crack Down On Medicare Advantage Overbilling

Medicare Advantage MAY 20, 201511:57 AM ET- Center for Public Integrity Senator Grassley asks the Justice Department to crackdown on Medicare Advantage billing. Senate Judiciary Committee Chairman Chuck Grassley has asked Attorney General Loretta Lynch to tighten scrutiny of Medicare Advantage health plans suspected of overcharging the government, saying billions of tax dollars are at risk as the popular senior care program grows. In May 19 letters to Lynch and Andrew M. Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, Grassley wanted to know what both agencies have done, together and apart, to stamp out overcharges that have plagued the privately run insurance program for years. "Safeguards become all the more important as Medicare Advantage adds more patients and billions of dollars of hard-earned taxpayer money is at stake," the Iowa Republican wrote. Medicare Advantage plans have gained popularity as an alternative to the government-run Medicare program in recent years, and the plans now cover some 16 million people. Grassley cited the Center for Public Integrity's investigative reporting, which found that CMS made more than $70 billion what the agency itself deemed "improper" payments to Medicare Advantage plans between 2008 and 2013. The concerns revolve around the accuracy of a billing tool called a "risk score," which is supposed to pay insurers higher rates for taking sicker people and less for those with few medical needs. But federal officials have struggled for years to track overspending tied to inflated risk scores. A 2009 agency study found that some plans had exaggerated how sick patients were to boost their payments, for instance. CMS also has acknowledged that faulty risk scores remain a costly problem, as the Center for Public Integrity first reported last year. "With the reported increase in risk score gaming, [...]

By |May 21st, 2015|Commercial Insurance, Medicaid, Medical Billing, Medical Credentialing, Medical Insurance, Medicare, Uncategorized|Comments Off on Grassley to Justice Department: Crack Down On Medicare Advantage Overbilling