Audit Benefit Plan Claims More Often

Any benefit plan that pays claims is exposed to errors and irregularities that improperly increase costs. Healthcare auditing companies are set up to review medical, prescription, and dental claim payments and provide needed oversight. But how often do you use their services? Most people with knowledge of the field advise that frequent audits are the best plan. Some even go as far as having auditors review their claim payments in real-time with monthly reporting. It’s a fact that you’ll add to your bottom line rather than subtract from it because claim reviews cost less than the errors they flag.

Not surprisingly, technological advances have helped, and when powerful software lands in the hands of people with medical billing experience, they maximize it. Specialist audit firms have built remarkably powerful and accurate systems that electronically review every detail. The combination is unmatched when you layer on their experienced review of the data and the chance to re-run any portion of the audit to produce more precise results. You can see why claim audits have become a strategic management tool for large employers sponsoring their benefit plans. It gives them needed oversight.

One of the newer wrinkles in the employee benefits area is a sudden rash of class-action lawsuits questioning fiduciary practices. Keeping your plan free from errors, well managed, and treating all members equally and fairly, with data to back it up, is wise. If your company is targeted with legal action and you have years of audit data to back up your assertions of careful plan management, you’re in a much stronger position legally. Unanswered questions or a lack of data can cause many complications that lawyers may seize on. Well-managed plans are always in the strongest legal position.

When interviewing prospective audit firms, don’t hold back with your questions. There are differences, and the lowest-priced product may not produce the best results. Like anything else in business, you’re looking for value – defined as getting the best service for the lowest price. If the reports or data are lacking in any way, you may wish you’d gone with a different firm. Finding companies that work exclusively in the claim audit field can also be an advantage. Learning the differences and specifics can make you a better shopper, and your plan will benefit. Good audits surface every detail in their reports.