More Accurate Audits Improve Self-Funded Medical Plans

on April 16 at 06:50 PM
Medical and pharmacy plans self-funded by mid- and large-size companies are both an outstanding employee benefit and a significant cost exposure. It's why the increasing accuracy of medical claim auditing firms makes a favorable financial impact. Today's best auditing (and continuous monitoring) methods review 100-percent of claims rather than only random samples. The plan audits that began to comply with ERISA and Sarbanes-Oxley have today become essential management tools with a dual focus on cost containment and improved plan performance. They benefit all self-funded plans.

The self-funded medical plans of government, municipal, and educational institutions can benefit from the same kind of auditing and monitoring services used by for-profit corporations. Anyone in an in-house position managing a self-funded plan should find out more about 100-percent audits and continuous claim payment monitoring. It only takes reading about one or two examples of improved performance to understand the potential benefits. For example, pharmacy benefit plans prioritize generics over name-brand-medications – is the claim administrator following through with generics?

As the expectations and responsibilities grow for in-house benefit plan managers, better auditing and monitoring improves performance. Having factual data about claim payments in hand significantly increases credibility and manages both the plan costs and the claim processor. Leading the conversation with irrefutable data speeds the process for correcting systemic errors with consensus. Besides helping manage expenses and plan performance, more accurate claim processing can also benefit members with high-deductible coverage. So, there are many ways greater auditing accuracy can help.

To get the maximum value from today's more accurate claim auditing software and methods, an increasing number of companies sign up for a continuous monitoring service. It means claim payments are reviewed in real-time and errors reported as they occur. It's especially effective at preventing large-scale problems because mistakes are flagged early before they become significant issues. It saves money, allows for systemic adjustments to avoid future errors, and makes it easier to recover overpayments. The added service is budget neutral or better and receives high marks from companies already using it. There is a remarkable improvement from the old random sample days.

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