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ARGUS IN THE NEWS

   

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

Health Insurance Claim/Billing:
A non-PPO ambulatory center issues a medical claim for $66,222.04

Reduced Medical Cost:
After comparing what the Centers of Medicare and Medicaid Services (CMS) would allow nationally and adjusting for the county’s Core Based Statistical Area (CBSA), ARGUS Claim Review was able to negotiate a savings of $36,172.64

>> Save with Argus Claim Review 

Powerful System Keeps Medical Billing in Check

A Watchful Eye on Health Insurance Claims
According to a report published by Thomson Reuters, the United States healthcare system wastes nearly $700 billion each year. But how does this medical waste directly affect consumers? It translates to rising medical costs.

Oftentimes, health insurance claims are billed inaccurately due to a simple medical coding mistake or other unintentional error. But in other cases, it is healthcare fraud – when health insurance claims are intentionally over-billed by providers who are trying to recuperate losses from low Medicare and Medicaid reimbursements. Higher charges then shift to self-funded employers, and when they aren’t caught, it causes rates and overall healthcare costs to climb.

Diligent Claims Review & Management
Argus Claim Review – featuring the industry’s most all-encompassing healthcare fraud protection system – is working to catch and correct these errors through diligent claims management every day. On average, we save our U.S. clients an estimated 46% per claim on billed charges. This is done through:

  • In-depth medical billing code and hospital cost (bill) audits
  • Medical necessity reviews
  • Identification of undocumented and unbundled charges
  • Detecting inappropriate and erroneous diagnostic codes, including CPT medical coding and ICD-9 procedure codes
  • Careful claim review of focus points – experimental treatment, chronic pain management, etc.