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 in-house staff does not directly control (and recheck) what is paid. Medical expenses are notoriously high, and when they go up, management wants answers. The only to reply factually is to take a look at claim payments.
The 100-percent review method used by today's best independent benefits claims auditing specialists is a far cry from the random sampling of yesteryear. Many also continuously monitor claims payments for their clients rather than waiting for periodic audits to uncover mistakes and discrepancies. The recent coronavirus pandemic sold more companies on the idea of monitoring continuously because it could help explain the COVID-19 related expenses and flag overcharges. The same mistakes could be caught later in audits, but everyone knows recovery long after the fact becomes more challenging.
When you're interviewing auditing firms, go for specialists rather than generalist firms that add facility claims auditing to their broader roster of services. The firms that do nothing else but audit benefit claims have particular expertise and can benefit from their experience in the service of your plan. When auditors work independently and quickly, it lessens the workload for in-house staff and produces excellent results. If you're never before seen an audit report from a company that checks 100-percent of claims, you'll be impressed. It gives more concrete data that can be used in meetings with TPAs.
Given the number of hacks and embarrassing information thefts recently, don't overlook data security when considering a medical claims auditor. You want one that has both electronic and physical safeguards in place to keep your data secure. The last thing you want is for your company to be in the news because of a security breach. It's easy enough to take steps not to avoid one, and most top-rated auditors are pleased to explain their precautions. The ones with the most secure systems tend to be the best firms anyway, and with them, you will enjoy a superior performance on many levels.