Navigation Links
In-Depth Health Claim Review Saves Client Up to $15,000 on Surgery that Fails to Meet Standards for Medical Necessity
Date:9/30/2013

Appleton, WI (PRWEB) September 30, 2013

Health care waste continues to be a growing problem in the U.S. with medical necessity as one of the core issues related to overspending. Today, more than ever before, consumers are undergoing tests, surgeries and procedures that aren’t considered necessary.

The Argus Claim Review division of Cypress Benefit Administrators is working to change this. It aims to proactively prevent these unnecessary medical treatments and uncover other costly health claim discrepancies to save employer-clients from excessive charges.

In a recent example, Argus Claim Review received a health claim that included electrodiagnostic (EDX) testing for a plan member with a resulting primary diagnosis of carpal tunnel syndrome (CTS). After two board-certified medical professionals further reviewed the case, there was insufficient documentation to warrant the EDX testing and the CTS diagnosis was deemed inconclusive.

The bilateral surgery recommended – carrying an average price tag of $10,000 to $15,000 – was also found to be unnecessary.

Tom Doney, president and CEO of employee benefits specialist Cypress Benefit Administrators, said that these types of cases are becoming all too common in the health care industry. “Our medical claim review specialists have always been meticulous about catching the typical coding and billing mistakes, but in recent years, they’ve had to start considering medical necessity as part of the equation.”

Upon seeing the CTS diagnosis and noting the lack of a full neurological exam after referral, an in-depth claim investigation by Cypress’s URAC-accredited partners was prompted by the Argus team. With several years of medical claim review experience, many past cases have shown that clients are commonly misdiagnosed with CTS instead of thoracic outlet syndrome or other conditions that often include similar symptoms.

The first expert, a board-certified neurologist, found that the EDX testing was not medically necessary as there was little description of history and response to more conservative measures like wrist splints or physical therapy.

The second review was done by a physician in orthopedic medicine who determined that the exam and EDX testing showed no definitive signs that the client had CTS.

Doney explained that employers who self-fund their employee benefits need to be extremely vigilant. “If it weren’t for this claim review, our employer-client would have had a surgery that cost thousands of dollars to fix a condition that wasn’t even present,” he said. “The effects go well beyond the price tag – a painful recovery, limited function and lost work time are just a few.” He added, “As a patient navigating today’s ever-changing health care system, being proactive is essential. Ask questions and make sure the tests and procedures your providers are ordering are medically necessary.”

Since starting business in 2000, Cypress Benefit Administrators, a privately held company headquartered in Appleton, Wis., has evolved into more than a third party administrator (TPA) by pioneering the way toward cost containment in health benefits. Cypress is the country’s first TPA to bring claims administration, consumer driven health plans and proven cost control measures together into one package. Its customized employee benefit packages combine an appropriate mix of health insurance options that allow for adaptability to the ever-changing healthcare environment and that make sense for employers of 50 to 18,000+ throughout the United States. For more information on Cypress Benefit Administrators with offices in Portland and Salem, Ore., Omaha, Neb. and Colorado Springs, Col., visit http://www.cypressbenefit.com.

Read the full story at http://www.prweb.com/releases/2013/9/prweb11168387.htm.


'/>"/>
Source: PRWeb
Copyright©2012 Vocus, Inc.
All rights reserved

Related medicine news :

1. CBT News Announces In-Depth Coverage of NADA Convention in New Orleans
2. AED.com Releases In-Depth Buyer's Guide
3. Info Security Leader Larry Brock to Provide In-Depth Insight on How to Protect Intellectual Property Against Insider and Cyber Threat
4. Report offers an in-depth examination of health centers role in family planning
5. Society of Interventional Radiologys new IR Quarterly focuses on features, in-depth news
6. Knoji Launches In-Depth Consumer Report Covering Leading DNA Testing Services.
7. AIUM 2013 Annual Convention provides an in-depth look into ultrasound first
8. "What is FOMO? – Social Media & Mental Health" Article Released by Birmingham Maple Clinic
9. Hormone Treatments / Diet Doc Hormone Diets & Weight Loss Plans Reveals the Keys to Extreme Weight Loss Diet Plans for Improved Knee Health and Less Knee Pain
10. Diet Doc Hormone Diets & Weight Loss Plans Introduce New Appetite Suppressants that Encourage Patients to Eat Healthy Food for Fast Weight Loss
11. Voxiva, Leader in Mobile Health and Wellness, Reaches Milestone
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... Oklahoma City, Oklahoma (PRWEB) , ... June 25, ... ... to helping both athletes and non-athletes recover from injury. Recently, he has implemented ... for the Oklahoma City area —Johnson is one of the first doctors to ...
(Date:6/24/2016)... ... June 24, 2016 , ... A recent article ... are unfamiliar with. The article goes on to state that individuals are now more ... these less common operations such as calf and cheek reduction. The Los Angeles area ...
(Date:6/24/2016)... ... ... Marcy was in a crisis. Her son James, eight, was out of control. Prone to ... , “When something upset him, he couldn’t control his emotions,” remembers Marcy. “If there ... my other children and say he was going to kill them. If we were ...
(Date:6/24/2016)... CA (PRWEB) , ... June 24, 2016 , ... ... is now offering micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience ... Damon brackets , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... People across ... in Genome magazine’s Code Talker Award, an essay contest in which patients and their ... award to be presented at the 2016 National Society of Genetic Counselors (NSGC) Annual ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... , June 23, 2016 Bracket , ... launch its next generation clinical outcomes platform, Bracket eCOA (SM) ... held on June 26 – 30, 2016 in ... first electronic Clinical Outcome Assessment product of its kind to ... #715. Bracket eCOA 6.0 is a flexible platform ...
(Date:6/23/2016)... LONDON , June 23, 2016 ... environments  Oticon , industry leaders in ... the launch of Oticon Opn ™, the world,s ... world of possibilities for IoT devices.      ... Opn, Oticon introduces a number of ,world firsts,: ...
(Date:6/23/2016)... 2016  Experian Health, the healthcare industry ... patient payment and care experience, today announced ... and services that will enhance the breadth ... These award-winning solutions will enable healthcare professionals ... in an ever-changing environment and redefine front-office ...
Breaking Medicine Technology: