Every year, the news gets better about the accuracy and performance of healthcare auditing companies. Their proprietary software can quickly review 100 percent of claims for any employer-funded medical or pharmacy benefit plan. With budgets under pressure at corporate and nonprofit employers alike and medical costs skyrocketing unendingly, ensuring accurate payments is essential. Many claims are complex and contain bundles of services. Discounts or other offsets can also be promised that must be handled correctly to avoid overspending. Auditors can review these areas for greater accuracy.
No doubt, improved technology makes an enormous contribution to accuracy improvements. But audit setup also plays a leading role. Firms that are more thorough take time to understand your plan’s unique provisions more closely and are careful in setting up each claim audit. When advanced systems are looking for every possibility, the audit report will likely turn up more. It adds little time to the audit and can pay substantial dividends. Claim auditing is a revenue-positive service because it turns up more recoverable errors than the service’s price, which is a selling point.
Remember to talk to an auditor first if you will soon switch to a new third-party medical claim processor or pharmacy benefit manager. They can schedule an implementation review around 90 days to give you an independent analysis of your new processor’s performance. Having outside and insightful verification of their excellent work is essential, and if hiccups are discovered, you can address them before you have a million-dollar problem. Improving claims processing accuracy is a realistic goal, even if you have error rates in the low single digits. With the cost of healthcare services today, it’s worth it.
The fact that all claims are reviewed today rather than random sampling also substantially contributes to accuracy and an audit’s value. Random samples showed patterns of errors but weren’t set up to detect every irregularity down to individual claims. When you have a report in your hands (or on your screen) detailing every mistake and overpayment, you are in an excellent position to decide which ones are worth recovering and correcting. When you request reimbursement for mistakes, providers also take notice. They realize your plan is well managed, and you will notice minor errors.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
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