Claim reviews like a medical or Rx audit can surprise you with the number of errors they flag. You’ll quickly understand why employer-sponsored plans increasingly require an independent auditing firm to double-check things. Medical and pharmacy billing is complex, and with prescription plans, you also have rebates and discounts – are they being adequately credited? The cost of auditing your plan’s claim payments periodically or continuously is significantly less than the value of errors it will find. You can also use the audit data with your claim processor. Letting them know you are watching always helps.
In the early days of claim auditing, random sampling confirmed only general trends but missed many individual errors. Today’s advanced systems powered by more sophisticated software are vastly more accurate. They “drill down” into complex data and check thousands of data points in minutes. It’s incredible to realize it takes less time to find more errors, and it costs less. If staff time at your company is tight, another advantage of today’s audits is how little of your time they require. The electronic portion of the review process handles nearly everything, and auditors can do the rest.
Significant budgetary fluctuations like the ones that occurred unexpectedly with the coronavirus pandemic hit the bottom line. For material costs, having thorough data to explain what happened is helpful for financial managers and C-suite executives. Answering analysts and stockholders goes more smoothly when management clearly understands. The best way to handle unexpected, extraordinary events is to have systems already in place. Trying to work retroactively and untangle complicated situations is always challenging. When you audit continuously, you can also compare periods easily.
Many employer-funded health and pharmacy plans switch among claim processors periodically. If you make a change, remember an implementation audit after 90 days. It will find errors or confirm things are being handled properly. Even if a new third-party processor or pharmacy benefit manager self-reports and promises ultra-low error rates, it’s still wise to double-check. Several plans recently have ended up in court with their claim administrators alleging costly errors and oversights – or promises not being kept. The ideal state is processing with zero errors; auditors can help you get closer to it.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228