The coronavirus pandemic was a wake-up call to many health, and pharmacy benefit plan sponsors about how quickly costs can skyrocket. It thrust health plan auditing services into the spotlight as never before and did the same for pharmacy claim audits. But there are very different opportunities for error detection and correct leading the recovery of funds for each plan. Therefore,...

The mission of every health plan, including those self-funded by large employers, is to serve members well and provide the care they need. But they are also large and complex financial undertakings that can bring significant financial issues when not closely managed. It's why medical claims auditing is on the front burner, especially since the coronavirus brought a spike in utilization rates....

Years ago, when large employers set up their self-funded medical and pharmacy benefit plans, there were regulatory requirements to schedule audits periodically. The plans complied, and auditing claims was standard practice. But as the years have gone past, audit software and methods have improved, and the reporting has become more accurate and detailed. The early techniques audited a...

Auditing firms with medical and other benefit plan claims expertise are again in the spotlight after the coronavirus pandemic. With most self-funded plans relying on third-party administrators (TPAs), medical claims auditing is a necessary form of oversight. New testing and treatment and lengthy hospitalizations for many people added up to enormous medical costs borne by large employers via...

The goal of every medical plan is to pay claims accurately and with consistency according to the plan documents for covered services. But with most self-funded plans now outsourcing claim payments to third-party administrators, there needs to be oversight to make sure things go as planned. It's where medical bill auditing services come in as they review the work of TPAs to check for...

In the early days of self-funded health plans, audits were looked on as a regulatory requirement rather than a plan management opportunity. But things have changed, and plan managers understand that medical bill auditing services play a crucial role in excellent plan management practices. Most claims today are paid by third-party administrators (TPAs), which means there is a need for...

Large employers, both corporate and nonprofits, have many incentives to self-fund the medical plans that cover their employees. But along with the advantages come significant responsibilities, and the financial exposure can be considerable. It's why plans today increasingly rely on their medical bill auditing services to keep tabs on claim payments. Most claims today are paid by...

Demands for accuracy and accountability are rising these days, and the expectations for self-funded health plan performance are no exception. You can see why medical claims auditing is increasingly called on to confirm the accuracy of claim processing and plan performance overall. The trend among self-funded plans to outsource claim payments had increased the need for oversight since the...

Years ago, self-funded medical plans relied on random samples when auditing claims, and there was an accepted level of accuracy that was far from perfect. But when technological advances in audit software brought significant improvements, auditing suddenly went from regulatory compliance to a strategic management tool. The leap ahead was the advent of 100-percent claim audits that reviewed...

When a large employer, whether corporate or nonprofit, makes the wise decision to self-fund a medical plan, some responsibilities accompany the benefits. One of them is ensuring the accuracy of claim payments, and medical bill auditing services are one of the best ways to do it. There was a time when many large plans had in-house staff to pay their claims. But by today, most have outsourced the...