Rotating Quotes ARGUS Claim Review – Medical Billing and Coding, Chronic Pain Management U.S.

Focus Areas

Argus in Action
– Sample U.S. Case Studies –

Health Insurance Claim/Billing:
An out-of-network hospital issues an insurance claim for $130,400.10

Reduced Medical Cost:
When ARGUS Claim Review receives an out-of-network hospital bill, we attempt to negotiate a discount. After discovering this hospital charged nearly 400% of the Medicare-allowed amount, the combination of discount negotiations and a prompt payment resulted in over $60,000 in savings

>> Save with Argus Claim Review  

Focus Areas

How Does Argus Review Healthcare Claims?
Argus Claim Review’s medical billing specialists are trained to identify any area of a health insurance claim that is even the slightest bit questionable. While we monitor every aspect of medical claim costs, our years of experience and constant eye on recent industry trends in U.S. healthcare have revealed common focus areas:

  • Medical Coding
    Making sure facilities and providers aren’t improperly unbundling or upcoding charges; ensuring that the appropriate Medicare (HCPCS codes) and AMA modifiers have been added; close review of all coding and billing
  • Chronic Pain Management
    Completing medical necessity reviews on all types of injections provided in the lumbar, thoracic and cervical regions as OIG found that over 63% of facet joint injections did not meet requirements in 2006
  • Experimental Cancer and Other Treatments
    Since new experimental treatments and drug therapies are constantly introduced, related healthcare claims are thoroughly reviewed for accuracy
  • Dialysis, Chemotherapy and Transplants
    Because these are among the most expensive medical procedures performed, Argus carefully monitors charges
  • Multiple Surgery, Assistant Surgeon and
    Anesthesiology Claims
    Surgery claims are checked to see which staff members completed procedures and if the proper modifiers are used when billing for anesthetics
  • Inflated / Erroneous Hospital Bills
    We scrutinize the numbers as a percentage off of a hospital bill filled with coding errors, unbundled or inflated charges, etc. defeats the purpose of the original discount
  • Electrodiagnostic (EDX) Testing
    These tests are monitored according to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines as they’re commonly associated with healthcare/medical billing fraud and abuse and often performed to generate revenue for the physician/facility
  • Therapies
    Conducting medical necessity reviews for chiropractic treatment and other highly abusive areas to determine if therapy is truly necessary or is maintenance in nature
  • Medical Upcoding Evaluation / Management
    Checking for coding and billing at a higher level of office visit than what was actually performed
  • Abusive Providers / Facilities
    Flagging the TINs of providers who’ve had issues with questionable medical billing and coding practices or behaviors and reviewing all healthcare claims associated with them