There's no doubt that employer-funded medical plans are on the receiving end of challenging news more often than not. Inflation, coupled with never-ending healthcare cost increases, keeps them under the gun. However, healthcare auditing companies offer relief with more accurate claim audits that flag mistakes and overpayments. Audit reports are also more detailed and precise, becoming better oversight and management tools. Coupled with today's audits reviewing 100 percent of claims, they offer much more to gain. It's easy to see why audits add to the bottom line rather than subtract.
The complexity of medical billing, with its thousands of service codes, also figures into the situation. It's why you want to work with an audit firm specializing in claim reviews. They can combine the needed audit methods with medical billing and coding expertise that can make a difference. When their systems are set up to analyze claims and check them, you can expect an audit report that is more valuable. When expenditures and utilization go up, having a detailed analysis of the trends is worthwhile. With third parties nearly always paying claims today, routine oversight is necessary.
There are key points in your plan's year when auditing can have the most impact, not to mention cover your fiduciary responsibilities and regulatory requirements. As the plan sponsor, you can select the opportune moment or have your claims payments checked throughout the year. Many auditors recommend the ongoing service as the best way to manage your third-party administrator. When months pass without an independent review, things may be occurring outside your view. Having an auditor working year-round assures you of a steady information flow that can often be useful.
The data developed by a claim audit depends on the system it runs on and the care with its setup. Your plan has specific provisions; the more the auditor understands (and respects) those, the more accurate the reporting will be. It's helpful to bring up priorities in the pre-audit meeting. Good auditors bring their knowledge and experience to the table, but hearing your concerns is also beneficial. When they are programmed into the system, you'll receive a more customized report with findings specific to your plan and its needs. The dual priorities for most audits are cost savings and service improvements.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
-- Edited by tfgpartners on Tuesday 2nd of January 2024 08:54:03 PM
-- Edited by tfgpartners on Tuesday 2nd of January 2024 08:54:44 PM
