If you’re involved in corporate benefits management, the type of review you select for your medical plan can significantly influence outcomes. Medical claim auditing services that perform comprehensive audits—checking 100% of claims instead of relying on random sampling—tend to yield much more precise results. By incorporating continuous monitoring into your strategy, you can achieve excellent oversight over claim payments, further enhancing accuracy. The advantage of this meticulous approach? Improved service for your plan members and effective cost management.
Audits and ongoing monitoring are crucial for plan management. You made a solid start when you finalized your health plan and chose a third-party claim administrator, likely a large health insurance provider. However, it’s essential to ensure that your organization isn’t overspending and that your employee members receive the care promised by your plan. Uncovering errors and inconsistencies can be quite revealing during your first audit. Many claim administrators make bold assurances about their accuracy and reliability, but nothing surpasses the insight gained through audit and monitoring.
Determining the cause of irregularities in claim processing can be challenging. It might be due to a claim processor misinterpreting a plan’s specifics or other factors at play. Regardless of the reason, conducting 100% audits and implementing continuous monitoring will provide transparency about the situation. Given the significant financial implications associated with a large, self-funded medical plan, staying informed is critical—especially with events like the coronavirus pandemic, which can swiftly affect healthcare expenses. A thorough audit can help clarify the accuracy of relevant claim payments.
Once you’ve reviewed audit findings, it becomes easier to advocate for a continuous monitoring program. This approach employs real-time audit software to immediately identify errors and patterns in claim processing. Because rising medical costs from self-funded plans can impact financial statements, potentially affecting stock prices and other factors, frequent audits and claim monitoring are essential for maintaining the direction of plans and their expenses. They also underline the importance of conducting thorough audits for improved accuracy instead of relying on random sampling.
