Given the cost containment they can support, a healthcare audit is a wise idea for all employer-funded medical plans. But don’t overlook the regulatory and compliance functions as well. Plans have fiduciary responsibilities, and audit reports give you documentation for documentation for ERISA requirements, the Consolidated Appropriations Act (CAA), and other relevant laws and regulations. Some plans have been hit with class-action lawsuits and settled out of court or paid judgments. The more data and oversight you have, the better, and claim auditors can help in all areas when they review your claims.

 

In the early days of audits, the technique involved random sampling and gave an idea of what could be improved. But flagging individual errors was elusive. With today’s technology and systems, it’s become fast and easy to double-check every claim. The level of accuracy is impressive and provides an opportunity to recover individual overpayments if financially worthwhile. When claim auditors find mistakes, it allows third-party administrators to make system improvements to prevent similar errors in the future. Over time, routine auditing tightens up the entire process.

 

Pre-audit meetings provide excellent opportunities to add specific questions to an audit inquiry. You can bring up areas of concern or places where you know (or suspect) errors occur. Specialist claim auditors work in the field daily and know where to look because they have checked every processor in the business. However, adding your own question list helps customize the audit and addresses your concerns. Using the same auditor multiple times allows audit reports to be formatted the same and easily comparable. You can gauge progress or concern in every major payment area. 

 

Health plan members benefit when claims are paid correctly and uniformly. Some members may be treated differently than others when there are mistakes or irregularities. It also matters for members with high deductible plans who pay out of pocket until certain annual minimums are met. Because a claim audit today reviews 100 percent of claims paid, the level of accuracy increases, and thanks to technology, the amount of staff time required is decreased. Auditors today can review thousands of data points in record time and drive down the cost of their service while improving the reports it produces. 

 

Company Name- TFG Partners, LLC

 

Address- 437 Grant St #1020, Pittsburgh, PA 15219

 

Contact Number:(412)-281-2228