If you ask any large employer sponsoring a health plan about claim payment errors, they would prefer zero. But even the most advanced processing systems can miss things occasionally. Medical claim audits are an excellent way to catch those mistakes so you can request reimbursement and prevent similar ones from occurring in the future. Today’s auditing that reviews every claim is a step ahead of the days of random sampling. It missed individual errors and caught only some repeating error patterns. It was better than nothing but fell short of today’s standards. Now, plans can detect every irregularity.
When auditors review claim payments, it also helps if they have experience on the billing side. Knowing medical and pharmacy billing and their services and products makes a significant difference. Auditing for tax and finance doesn’t require the medical knowledge of health plan auditing, and it’s why finding a firm concentrating in the field is helpful. Also, there are many changes in medical and prescription billing every year as products and procedures advance. Understanding the latest details and how treatments should be coordinated also helps auditors produce better reports; their data is excellent plan oversight.
Medical providers are more vigilant about billing accuracy when they know plan sponsors review their claims. Any plan with greater oversight and tighter management receives more care and attention. The promise to members is excellent care, and the fiduciary responsibility is to get the care for the lowest possible price. With medical and medicine costs escalating annually, it’s a never-ending struggle to manage budgets and protect the bottom line. A big selling point for claim auditing is its cost compared to its identified savings. It’s a cost-saving opportunity more than an expense.
Thorough claim auditors can also check findings by comparing them to results from other recent audits and past audits of your plan. Each review presents opportunities to improve a constructive relationship with your plan’s claim administrator. System fixes originating with your audit may bring savings for other plans running on the same platform. You can also decide how to pursue reimbursements and whether to request repayment for every overcharge. When new products and treatments come online, their charges deserve careful review in the first several months.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
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