While providers are exceedingly familiar with the traditional payer-based process for appealing claim denials, remarkably few know about ERISA appeals. The Employment Retirement Income Security Act of 1974 (ERISA) gives providers a federal avenue to pursue additional reimbursement—and it picks up where the traditional appeals process leaves off. Designed to protect the rights of beneficiaries […]
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Featured Blog Posts
Frequently Asked Questions about ERISA Recovery for Healthcare Claims
By Argos Health
Even among the most seasoned healthcare revenue cycle experts, ERISA appeals are often a new concept. By our estimates, as many as 98% of provider organizations do not realize they can expect a 1% increase in net patient service revenue by exercising the appeals rights granted to them by the federal ERISA law. Because Argos […]
Why Don’t Hospitals Know they Can Recover Millions through ERISA Appeals?
By Argos Health
By our estimates, as many as 98% of provider organizations assume that health plans have the last word in coverage decisions and reimbursement rates. Often, they don’t. Most private-sector health plans are actually subject to the Employment Retirement Income Security Act of 1974 (ERISA). This means that providers are typically owed millions of dollars in […]
Hospitals Can Recover Lost 2020 Revenue through ERISA Appeals
By Argos Health
The average hospital claim denial rate increased 23% in 2020, but those funds may not be lost. Two little-known COVID relief measures opened a new route that may allow providers a second chance at recovering 2020 revenue. It’s not through the traditional state-governed appeals process. In May, the federal government issued two COVID relief notices […]