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:4/26/2017)... ... 26, 2017 , ... RawTrition now brings you BioEnergy which is a powder ... , RawTrition is taking nutrients to the next level! The superfoods ... its raw form (unlike the synthetically made options that are on the market). , ...
(Date:4/26/2017)... ... April 26, 2017 , ... New SUPRO® ... ready-to-drink, high-protein beverages by helping beverage manufacturers more effectively manage protein costs. “Soy ... cost savings as well as more stable pricing over time. Now it’s even ...
(Date:4/26/2017)... FL (PRWEB) , ... April 26, 2017 , ... ... and human performance, is proud to announce that it has received 510(k) clearance ... technologies, the MyoCycle Home and the MyoCycle Pro. , Both devices are stationary ...
(Date:4/25/2017)... , ... April 25, 2017 , ... ... and collaboration, announces Mirroring360 Pro . This new addition to the Mirroring360 ... experience for education and business. , Mirroring360 Pro enables educators, business professionals and ...
(Date:4/25/2017)... , ... April 25, 2017 ... ... in Newport Beach, California, committed to raising awareness for Duchenne muscular dystrophy, ... from its randomized CAP-1002 (cardiosphere-derived cells) Phase I/II HOPE clinical trial in ...
Breaking Medicine News(10 mins):
(Date:4/19/2017)... NEW YORK , April 19, 2017 Cardiology ... during the projected period The Cardiology Devices segment ... more than US$ 15 Mn in 2018 over 2017. By ... reach a market valuation close to US$ 700 Mn, expanding ... Cardiology Devices segment dominated the Asia Pacific ...
(Date:4/19/2017)... YORK , April 19, 2017 ... This report on the prostate cancer therapeutics ... the global market. Increasing prevalence of prostate cancer, ... innovation in the development of new drugs & ... prostate cancer drug due to lesser side effects ...
(Date:4/19/2017)... LONDON , April 19, 2017 ... to stimulate an immune response in pets such ... vaccine products are of various types such as ... Vaccines, Toxoid Vaccines, DNA Vaccines and Recombinant Vaccines. ... such as virus or bacteria, which have been ...
Breaking Medicine Technology: