Working with medical claim auditors is enlightening for any medium or large-size employer-funded health plan. One of the most interesting comparisons is to look at plan performance before an audit’s recommendations were implemented versus after they took effect. The most noticeable improvements are eliminating systemic errors, but individual mistakes can also add up. Today, claim administrators promise to drive error rates into the low single digits. But are they keeping their promises? Only an auditor’s independent review can say for sure – and it’s helpful to have your claims reviewed.
One of the most prominent places for a claim administrator to make payment errors is to overlook some of your plan’s provisions. If they are unique or different from most other plans the processor administers, there’s the possibility finer details will be overlooked. A thorough audit can shed light on the situation if you’ve been with the same administrator for a while. If you’re starting with a new administrator, scheduling an implementation audit after 90 days is wise. Catching errors early saves you money and the inconvenience of recovering overpayments. You’ll quickly see that it can matter significantly.
Technology and the increasing expertise of auditors in medical billings have led to vast improvements in audit accuracy. Ever more powerful and intuitive software allows electronic reviews that are fast and highly accurate. It’s a far cry from the days of random sampling with heavy human intervention. Today, the electronic portion of a claim review finds and flags an impressive number of mistakes while double-checking 100 percent of claim payments. If you like a “by the numbers” type of analysis, it’s routine for claim audits to find recoverable errors of up to four times the audit’s price.
There’s also a beneficial effect on everyone involved when you run careful oversight. Despite promises for accuracy, it’s natural for people to be more cautious when they know you’re reviewing their work. Routine audits that flag irregularities shortly after they occur are the best. It’s easier to work in real-time than longer in arrears. When the same auditor reviews your plan routinely, they have a basis for comparison. When or if things change, they will likely notice and be able to give you warnings far ahead. Some changes may be expected, while others deserve your scrutiny.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
