Technology continues to improve systems, helping each healthcare audit become more accurate. It’s one of the reasons employers funding benefit plans increasingly audit their claims or review them continuously. Nearly all claim administration today is outsourced, and most processors deliver impressive accuracy. But there are always some errors and room for improvement and recovering overpayments. Plan sponsors have learned they have everything to gain and nothing to lose with frequent auditing. When budgets are under stress, and costs are skyrocketing, accuracy matters more.
When your plan’s specific provisions are carefully loaded on today’s powerful audit software, it’s possible to review every claim down to tiny details. Auditing at that level and on systems with an understanding of medical billing produces accuracy as never before. Even sophisticated claim processing systems with many built-in safeguards can miss things auditors pick up. It gives in-house plan managers the ability to conduct oversight efficiently and is a valuable practice for medical and pharmacy benefit plans. Because electronic reviews have become so powerful, it brings audit costs down and helps your budget.
Another incentive to audit claims routinely is the cost containment opportunity. It’s common for a claim review to find mistakes with a value of four times the audit’s price. When auditors suggest claim processing system fixes, it prevents future errors and keeps all processing more accurate. When an extraordinary event like the coronavirus pandemic comes along, having a handle on your claim payments and processing accuracy matters more than ever. It’s a lesson that many health and prescription plan sponsors learned recently. It’s also essential to pay claims and treat members equally.
If you manage an employer-sponsored health plan, bring your most pressing questions to the audit setup meeting. When systems are set to review the points most of interest, they are excellent additions to a claim auditors’ customary list. Going with a firm that specializes in reviewing claims and understands medical procedures and their charges, you have a leg up. Their expertise works in your favor and adds value you wouldn’t have with a generalist auditor. Much of the audit world is focused on tax and finance (numbers only), and medical claims go beyond their usual expertise.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
