The coronavirus pandemic put a unique stain on many systems in society and none more heavily than employer-funded health plans. They took a beating, and many lessons were learned, as medical claims auditing has shown us in the pandemic’s aftermath. There were new tests and treatments with wildly varying price tags and higher utilization across […]

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. […]

Claim reviews from healthcare auditing companies continue to become more sophisticated thanks to system improvements. Specifically, more powerful and accurate software and audit setups bring reports more quickly and are packed with factual data. It’s a night-and-day difference from previous random sample claim auditing that mostly caught only repeating and systemic mistakes. Now, it’s possible to report every irregular claim for […]

All health plans, especially those self-funded by large employers, try to find ways to deliver excellent care at the lowest possible cost – but it’s never easy. If you’re in-house at an employer-sponsored health plan, consider medical claim auditing services to help with cost management. You likely have an outside processor handling claim payments, and […]

Overpayments are other irregularities that can strain health plan budgets, and medical claim audits are one way to correct them. Discovering and reporting each mistake is one of the chief outputs of a claim review and can save plans significant sums. With nearly all claims today paid by third-party processors, it leaves employer-sponsored plans in the dark. […]