When large employers, corporate or nonprofit, fund their employee benefit programs, a lot of cash goes on the line. Therefore, running a healthcare audit to confirm the accuracy of claim payments is a must. Today, auditors produce far more accurate results that greatly enhance the value of their services. The ability to review every payment against your plan's provisions means any irregularity can be flagged and reviewed. It's a far cry from the early days of claim reviews, where general error patterns were detected, but many individual errors slipped through the cracks. It helps control costs and treat members fairly. 
 

Why are benefit plan claims audits today significantly more accurate? The primary explanation is technological advances. The systems in use today have been refined over the years and begin with more powerful abilities. Each claim has dozens of data points to review, and each one may have nuance. When systems can cope with those demands, the electronic portion of an audit is automatically more accurate. Professional oversight to review the finding is always valuable, and sometimes parts of audits can be re-run to look more precisely at specific areas. An auditor's experience eye always adds value.

Anyone who has been around the industry for a while or studied the early days of claim reviews knows it used to be all (or mostly) random sampling. It was the best available method and produced valuable insight. But today's robust 100 percent claims reviews leave those methods in the dust. The outcome is entirely different when every claim is checked, and all errors are flagged. Overpayments can be recovered at all levels, not just large repeating error patterns. Auditors report their findings, and it's always the plan sponsor's decision about whether to pursue recoveries in a group or individually.

Setup and reporting are also important quality factors in claim auditing. Set up significantly improves accuracy when it's done carefully and thoroughly. Every plan has unique provisions, and carefully considering them is essential. It enhances the claim review's ability to pick up all errors and report them comprehensively. Audit reports today have also improved and are much more user-friendly. Specifically, they are easier to read and require less decoding – in other words, they are written in plain language and avoid audit jargon. Good reporting is helpful if you manage a plan and need to understand the data.

Company Name- TFG Partners

Address- 437 Grant St #1020, Pittsburgh, PA 15219

Contact Number: (412)-281-2228