When Will Your Plan Audit Claims This Year?
Costs increase for large employers funding their medical and pharmacy plans each year. Therefore, it’s crucial to double-check claim payments routinely with a healthcare audit to assure accuracy. Outside administrators, these days, often drive error rates to impressively low single digits, but confirming their accuracy always matters. Also, when you work with experienced claim auditors, they bring knowledge to the table, allowing them to make insightful recommendations. The best audit reports contain ideas for system improvements and other cost-saving initiatives that add to your bottom line throughout the year.
Some annual milestone events suggest optimal timing for a claim audit, either before or after they occur. Or you can have audit software running continuously with monthly reporting. The data you receive gives you a second opinion about your pharmacy benefit manager’s work. Given the excessively high cost of many medicines today, looking closely at each claim paid matters more than ever. The opportunities for savings exist, and they also do for member service improvements. One of the most important things is to adopt fiduciary best practices and ensure funds are spent carefully and equitably.
Claim auditing has evolved from a regulatory and compliance issue to more of a plan management tactic over the past 20 years. It has occurred as audits have become more accurate and their reports actionable for plan sponsors. There is also the realization that audits add to the bottom line because they flag recoverable mistakes. It often happens that recoveries total four times the price of the audit service. Specialist claim-auditing firms have also stayed ahead of the curve, improving their software and systems. Today, it’s common for them to review 100 percent of claims and check them comprehensively.
As you’re interviewing prospective auditors, asking questions about their service and discussing your plan’s needs and experience is good. You’ll know you’ve found the right people for the job when you hear answers that respond best to your needs. All firms are not alike, and their methods and systems differ. Some who have pioneered leading-edge techniques make more of a contribution because they make suggestions based on knowledge. Firms with principals with plan-side medical billing and claim payment knowledge have the most to contribute; they understand the ins and outs.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number- (412)-281-2228
