Most healthcare providers believe that health plans have the final authority to set allowed reimbursement amounts, but that assumption is often false.
DALLAS (PRWEB) February 01, 2021
Argos Health, a leading provider of complex claims revenue cycle services to hospitals and health systems, today announced a new service line dedicated to ERISA appeals. This highly specialized service will help providers recover millions in underpayments from health plans covered by ERISA.
"We believe ERISA recoveries are a largely untapped opportunity in the hospital revenue cycle,” said Brent McCarty, Chief Executive Officer at Argos Health.
Most healthcare providers believe that health plans have the final authority to set allowed reimbursement amounts, but that assumption is often false. The majority of commercial and managed care health plans are subject to ERISA, which generally applies to all employers except governments and churches. ERISA requires that reimbursements must be made in accordance with the terms of the written plan document. In most cases, ERISA takes precedence over state laws and conflicting contract terms.
The additional revenue recovered through ERISA appeals can be substantial—it’s not unusual for the typical hospital to see $1M+ in incremental annual reimbursement.
ERISA is complex and constantly changing. Congress, government agencies, and courts all have a hand in defining the obligations of ERISA plans and the rights of hospitals and health systems to reimbursement from ERISA plans. Most providers do not have the necessary internal resources to successfully and consistently appeal ERISA underpayments.
Argos Health has recruited two healthcare experts to lead its ERISA service line team. Troy Roth is one of the most accomplished revenue cycle professionals in the industry, with almost 30 years of experience in provider, vendor, and startup settings. Mr. Roth will serve as Senior Vice President, ERISA Services. Lea Fowler, a noted ERISA expert with over 10 years of ERISA claims appeal expertise, will serve as Director, ERISA Claim Services.
"Argos is continually searching for new complex claims services to add to our offerings," McCarty added. “We're excited to educate providers on the benefits of our ERISA service at a time when hospitals and health systems are under strain from COVID-19 and can use every dollar of additional revenue, including benefits offered under the US Department of Labor’s 2020 EBSA Disaster Relief Notice."
To learn more about Argos Health's ERISA services, visit https://complexclaims.com/erisa_appeals
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About Argos Health
Argos Health is a revenue cycle partner specializing in the management and resolution of complex claims. The company works with hospitals, health systems, and physician groups to drive reimbursement and increase claims recovery through their core services of workers' compensation, motor vehicle accident, out-of-state Medicaid, ERISA, US Department of Veterans Affairs and other military claims, and additional complex cases. Argos Health has been ranked #1 in the Complex Claims Solution Vendor category in the last two Black Book Hospital CFO Surveys and is a top-ranked KLAS vendor. To learn more, visit: http://www.complexclaims.com.