Medical claims administration is a detailed business, and for companies with self-funded plans, there is significant financial exposure. It's why medical claim audit companies that work with a full-service approach are in such demand. The errors and overcharges they uncover and help correct during audits can save significant amounts of money for years to come. They are essential allies in improving plan performance and efficiency. While periodic audits may be regulatory requirements, there are many good reasons to schedule one routinely as a valuable management tool. They make a difference.
If you're a benefits plan manager and are hearing the term full-service for the first time related to auditing, it's wise to learn more. Full-service firms view the audit as the first step in a four-step process. It means they go beyond data gathering and partner with you to recover payments made in error. They also help improve claims administration systems to prevent the same mistakes from repeating in the future. It means a more fair and efficient administration of benefits to all employee-plan members – and is a consistent cost containment tool. The best auditors now review 100-percent of claims.
Fund recovery for incorrect and payments made in error is the third part of the full-service audit approach. The sums involved can be considerable, and the return of those dollars to your budget can make a significant difference. Every year, medical costs increase, and the financial pressure on self-funded plans is intense. Auditing 100-percent of claims and making appropriate recoveries to eliminate errors is your best defense against rising costs and budgetary overages. Your corporate finance team will be impressed by the greater accuracy and recovery of funds that will become routine practices.
Ongoing advocacy with your claims administrator from your auditor can go a long way toward keeping things on track. Some auditors go as far as outreach to providers themselves to discuss medical billing issues. Your company pays claims in a sincere effort to take care of its employee-plan members. It means plan dollars should be reserved to meet those needs and not lost to incorrect charges or overbilling. It can be easier for the auditing firm to have tough conversations than it is for the company's representatives. Knowing there is oversight leads to more responsible actions.