Independent Claims Auditors Deserve the Praise They Receive

on May 29 at 07:52 PM
When it comes to improving the management of self-funded health plans, few who have a role to play in the process can match the importance of independent auditors. Effective medical claims reviews help in-house plan managers have oversight of their claim processing, which third-party administrators generally handle. Today's 100-percent audit methods produce an impressive level of oversight, catching virtually every error and irregularity. A good audit report and follow-up help with overpayment recovery and suggest systemic improvements that prevent future mistakes.

In-house plan managers handling self-funded benefits programs are wise to select claim auditors carefully because of their potential to make a favorable impact. Auditing firms with specialized experience and software arrive ready to help the most from day one. They have unique expertise gained from auditing millions of medical claims each year, checking for errors of all kinds, and working with a notable level of efficiency and accuracy. Generalist auditors that may provide claim auditing as an ancillary service rarely have similar expertise. Independent specialty firms have greater expertise.

If you're reviewing claim audit firms and their capabilities, keep an ear out for those that work with the 100-percent method. It's a leap ahead from random-sample audits that have a tough time measuring up. When every claim paid is reviewed for accuracy, it provides an unmatched level of oversight that impacts plan performance. The objective is to serve members well and contain costs. As prices for virtually every medical service increase each year, paying the agreed-on price and not overpaying for services becomes crucial. High-performing audits recover more than they cost.

Lastly, don't overlook data security. In today's world, safeguarding your employee-members' personal information is of the utmost priority. Ask audit firms about two levels of security – electronic and physical. Security breaches are costly and embarrassing in terms of bad publicity for your company. Today's best firms offer excellent security assurances and take protecting your data seriously. When you select an auditor with all of the best attributes, you're on the way to improving your plan performance. Members will be served better, and the bottom line will benefit from the oversight of your self-funded plan.

Comments (0)