Everybody has experienced the problem of rising medical costs. As the United States Department of Health & Human Services reports, there is $250 billion worth of waste in healthcare annually. And one of the biggest contributors to these costs are claims that are billed inappropriately and fraudulently by providers looking to make up for losses due to low Medicare and Medicaid reimbursements by shifting costs to self funded employers.
At Cypress Benefit Administrators, we are continually on the lookout for ways to save our clients money on their medical expenses. As a part of this effort, we've instituted the most all-encompassing fraud protection system available with ARGUS Claim Review. Named after the Greek Mythology's 100-eyed guardian who never sleeps, this groundbreaking program is constantly on the lookout for claim errors and vigilant in its efforts to catch and correct them.
Many of our clients have experienced the significant savings generated by ARGUS Claim Review (formerly Sentinel Claim Review), a division of Cypress that focuses its daily efforts on claim auditing, review, cost management and negotiation on behalf of our clients. So far in 2009, ARGUS Claim Review has saved Cypress clients over $1.1 million due to its diligent efforts at identifying claims that were billed incorrectly or those that can be negotiated with savings beyond that offered by PPOs.
ARGUS reduces costs and produces better outcomes by focusing on:
- In-depth bill audits
- Medical necessity reviews
- Identification of undocumented and unbundled charges
- Inappropriate and erroneous coding
While some claims surveillance systems only focus on large claim negotiation, ARGUS goes much further to protect our clients' dollars by using trigger points such as:
- In- and out-of-network claims of over $10,000
- Dialysis, chemotherapy and transplant claims
- Specific revenue codes and modifiers
- Specific "J Code" or injections
- Pain management services
- Multiple surgeries, assistant surgeons, and anesthesiology charges
If you are one of the many clients who have experienced savings through ARGUS, you know the value that it brings. If you have yet to see a significant impact from the ARGUS program, we are certain that you will soon. Speak with your Cypress Account Executive about ARGUS Claim Review and our ongoing efforts to control health care costs -- or any of our other medical risk management and cost containment programs.