Argos Health has a dedicated team of individuals specializing in Veterans Affairs (VA) related claims. These accounts require specific medical documentation and proper authorization for all services provided to a Veteran within a designated amount of time to streamline the processing, approval and payment of the claim.
Argos Health offers a “Day of Discharge” assignment to the claim, allowing for prompt and proper deliver of claims to the VA. Our team will verify claim receipt with the VA and perform timely follow-up on each claim in order to expedite resolution.
VA claims have unique rules and regulations with further complexities involved in the denial and appeals process. We work with the provider to manage these complicated cases successfully in order to obtain accurate payment in a timely manner.
Clinical denials often hold their own set of unique challenges due to the need for clinical knowledge paired with an understanding of patient financial services and billing expertise. This creates complexity due to various departments needing to work together in order for the claim to get paid.
Our staff of nurses, billers, and legal experts work as an extension of your team to successfully manage and reverse clinically-denied claims. Our team can help navigate denials and increase collections.
Each payer brings its own unique rules and regulations for authorizations and the process required for appeals. We are quipped with a complete understanding of payer requirements to help with the processing of these claims and the appeals process.
In addition to resolution of clinical denials, we work diligently to identify the root cause and determine process improvements to reduce the number of clinical denials. Our goal is to alleviate the administrative frustration caused by these claims, increase reimbursement and lower the overall amount of clinical denials.
Providers have specific responsibilities with their Medicare patients to determine the correct order of billing. CMS requires this coordination of benefits for every admission, outpatient encounter or episode of care. Completion of the Medicare Secondary Payor (MSP) questionnaire is the one form that meets the need and allows the provider to submit their bill.
The provider has a huge task: research the primary coverage, avoid incorrect and determine Medicare’s correct level of responsibility. All of this must be done while conveying a complex level of information to the patient and engaging them in the process so that the MSP questionnaire is completed correctly, with minimal effort and impact on hospital’s billing cycle. This tedious and time-consuming process must also be performed with an eye towards compliance with the rules and regulations set in place to achieve proper reimbursement. Our staff are trained in the MSP regulations, Coordination of Benefits rules and billing guidelines so that they understand all of the nuances involved and can easily explain, in working terms, why this process is important to your patients.
Let Argos Health assist in implementing an MSP completion process where our experienced staff serve as an extension of your team to help avoid costly billing delays and potential denials.