People in many technical fields speak a language all their own, but it can diminish the value of their work when communicating outside their specialty area. With medical claim auditing, concise and easy-to-read reports increase the value of the audit and the ease of taking action on its findings. Improved technology covering 100 percent of claims processed helps electronic reviews find and flag more irregularities than random sampling could in the past. When the results are reported in a readily usable format, they can be used immediately for corrections and recovering funds. It's one reason plans audit more frequently. 

After a claim review, the low-hanging fruit is catching and correcting systemic errors. But with 100 percent audits when every claim is reviewed, it can be worth recovering funds from individual mistakes that add up over time. The results improve when it's easy to pull that data from reports and use it immediately. It's also a good point to talk about the timing of audits. Most large employer plans audit more frequently these days because oversight has become a budget-friendly process more than ever. Audit firms today handle more of the process than ever, which means the time in-house staff spends is further reduced.

Depending on your plan's experience and the complexity of your claims administration, another option is to have processing and payments monitored continuously. Auditors can have their software running unobtrusively in the background and make monthly reports. The standard thinking is that continuous review is one of the best defenses against developing million-dollar problems. Ask anyone who has worked in funds recovery, and they'll tell you that making requests soon after the error is much simpler. Trying to recover funds after several months or a year can be a more complicated process.

Remember to schedule an implementation audit when you move claim processing to a new third-party administrator or pharmacy benefit manager. The ideal time is generally 90-days after the switchover because there is sufficient work to review. If you wait longer, it risks more significant problems, and going sooner means you may miss things that have yet to go through the system. The reports from an implementation audit need to be equally clear and actionable. It's the moment when you bring the claim processor in to discuss the improvements required and agree on the plan to make them.

Company Name- TFG Partners, LLC

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

Contact Number:(412)-281-2228