The Most Complete Claim Audits are Best
Auditing every claim of a self-funded medical plan is the most effective approach to uncovering overpayments and recovering those excess amounts. This is why top medical claim auditing firms thoroughly review all claims rather than relying on a random sample. The primary goal is to enhance claims payment accuracy while reducing operational costs and providing excellent service to members. Identifying and correcting systemic errors in claims processing can lead to significant savings. An efficiently running plan serves its members better and maintains lower costs year after year.
One critical area of focus for premier medical plan auditors is ensuring that the claims processing aligns with the plan’s specific objectives. Unfortunately, it is common for processors at large medical carriers to adhere strictly to their standard procedures, neglecting the unique requirements of a self-funded plan. Aligning claims processing with the plan’s intentions not only benefits members but also aids in managing expenses. Comprehensive operational reviews by diligent auditors can highlight recoverable overpayments and help prevent future errors, enhancing processing efficiency in various ways.
Given the substantial cost-saving potential, it’s no wonder that 100-percent claim audits are considered valuable strategic management tools—especially in light of the surge in COVID-19 claims, some of which involve exorbitant charges. The rationale for conducting advanced audits today extends far beyond merely meeting ERISA and governmental standards. There are meaningful opportunities for plan enhancement and cost reduction when systemic issues are pinpointed and rectified, ultimately improving plan performance and benefiting employee members.
Additionally, many forward-thinking companies and plan managers are exploring the option of continuous claim monitoring. Auditing firms offer this service, enabling real-time oversight of claim processing and payments. It is a budget-neutral service since the savings from errors typically outweigh the cost of the service itself. Furthermore, it aids in explaining sudden cost spikes for self-funded plans that could influence quarterly earnings reports. This service is also advantageous for members with high-deductible plans, as they benefit when mistakes are detected and rectified across all claims.
Organizer (1)
- Organized by
-
-
Sorry, there were no discussions found.
You must be logged in to create new discussions.