Large employer-funded health plans are best known for frequent medical claims auditing because correcting mistakes saves them thousands of dollars. But many others benefit from correct claim payments, including the providers billing the charges. Incorrect coding and other errors on claims can result in undercharges and lost revenue that adds up. Independent auditing firms specializing in claims reviews can make a difference for medical practices, surgery centers, outpatient clinics, and hospitals. Today it's routine to examine 100 percent of claims in an audit, improving accuracy exponentially.

Frequent medical claim auditing makes sense for providers such as medical practices because it's extra work and lost revenue when mistakes happen. Making refunds to payers for overcharges and errors affects cash flow and ultimately hits the bottom line. Correct billing is always the way to assure stability and profitable operations. It also means measuring your business progress based on revenue is reliable and not subject to change or surprises. An increasing number of health plans today employ auditors for a continuous monitoring service. It's an innovative way to watch claim payments for errors in real-time.

Technological advance in auditing software has been transformational because it has reduced human involvement and boosted accuracy. Reduced labor costs and a quicker route to the audit data keep costs down and make claims review more budget-friendly. On the payer side, audits today can find as much as four times in savings as the price for the service. It has the attention of plan sponsors and is why medical practices need audit-driven billing improvements. When everyone reviews claim payments more closely, there's little room for errors – getting it correct the first time is the best way.

Medical claim auditing also commonly extends to pharmacy benefit plans that are complex to administer with formularies, discounts, and other factors. Given the high prices of some medicines, billing and dispensing errors can be costly if they go undetected and unrefunded. Continuous monitoring that reports monthly is the best way to keep mistakes in check, but if not, then periodic auditing is another option. Claim auditing is generally thought to be a financial tool, and there is no questioning its benefit, but there is also a member service component. People are treated fairly when claims are paid correctly.