Audit 100-Percent of Medical Claims and See a Difference

on April 21 at 11:30 AM
If you're in corporate benefits management, the kind of audit you choose for your medical plan can have a significant impact. Medical claim auditing companies that use a 100-percent method – rather than random samples – produce a far more accurate result. If you then take the extra step of adding a continuous monitoring service, you'll have an exceptionally high level of accuracy in your claim payment oversight. What's the benefit of watching things this closely? Better service to your plan member and effective cost containment. Audits and monitoring are the answer to more effective plan management.

When you finalized your health plan description and decided on a third-party claim administrator, most likely a major health insurance carrier, you took the first steps. But more is required to make sure your company isn't overspending and your employee-members are being cared for as your plan intends. It can be a significant surprise the first time you audit and find errors and discrepancies. Most claim administrators make lofty promises about their accuracy and infallibility. But nothing replaces an audit and monitoring to see what's happening. It lets you, as the manager, have the oversight you need.

When there are irregularities in claim processing, it's never easy to tell whether it's a claim processor following standard procedures and overlooking a plan's details – or something else. But whatever the cause, 100-percent audits and ideally continuous monitoring from now on will report on what's happening. Given a company's financial exposure with a large, self-funded medical plan, a lot is at stake when things don't go as planned. Also, unique events like the coronavirus pandemic have an enormous and quick impact on health care costs. 100-percent audits can clarify the accuracy of related claim payments.

Once you see what is turned up in an audit, it's not difficult to make a case for a continuous monitoring program. It utilizes the audit software in real-time to report mistakes or patterns of errors in claim processing. Because increases in medical costs from self-funded plans can turn up on balance sheets, they can affect stock prices and much more. All of these will support the value of frequent audits and claim payment monitoring to help keep plans and their costs on track. They also demonstrate why auditing 100-percent of claims for improved accuracy is preferable to random sample auditing.

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