Companies that self-fund their medical and prescription medication plans are legally obligated to have periodic audits. But with the potential savings involved, being proactive about claims administration reviews is a wise idea. The best medical audit companies are known for reviewing 100-percent of claims, which is a vast improvement over the prior random sample methods. If you're in charge of managing a company benefit plan, having adequate oversight of your claim administrator is essential – and only a 100-percent audit provides you with the data. It helps you run a more efficient self-funded plan.
What are some of the most frequent claims processing errors uncovered by audits? A significant one often is filling prescriptions with more expensive name-brand medications when generic products are available. This practice adds no value for employees who are members of the health plan, and it adds tremendous cost to each prescription filled. An excellent claims audit will uncover these kinds of errors by the administrator and save thousands of dollars when corrected. Over time, savings like this accrue, and for larger corporations with self-funded plans can bring dramatic cost savings.
If you're the one responsible for managing a company's health plan, imagine the kudos you'll receive for eliminating errors and saving money while serving members excellently. It's a given that claims administrators will do a more conscientious job when you provide management oversight based on factual data. Only auditing 100-percent of claims produces the accuracy you need to do an outstanding job of managing your plan. If you're called by upper management of your company's finance professionals to report on the plan's budget, have concrete data also is an asset.
The additional step you can take to run an excellent plan is known as continuous claims monitoring. It is a service where an auditing company will review your claims in real-time. It means errors are caught immediately, and you'll solve any problems while they are still relatively small. Costs for this service are generally budget neutral or better because the value of the errors reported to you (and corrected) is far greater than the monitoring service price. Benefits plan managers seeing the results of continuous monitoring reports for the first time are often surprised by the precision of the data gathered.