TFGPartners's Blog (9)

Large corporate and nonprofit employers providing medical and prescription plans for their employees have significant financial stakes in ensuring the accuracy and efficiency of their claims processing systems. Given the magnitude of financial transactions involved, it becomes evident that medical claim auditing services are vital components…

Over the years, many larger employer-funded benefit plans have opted to outsource claim processing to large insurance carriers and pharmacy benefit managers, touting cost savings and superior results. However, the promises need verification by doublechecking claims in a medical and Rx audit to ensure commitments are being upheld and potential…

Large dollar amounts in medical and pharmacy plan claims make healthcare audit services a top priority for most plan sponsors. Regulations mandate that plans act in the best interests of their members, and accurately paying claims is vital. It is a significant concern for corporate and nonprofit employers who sponsor their plans…

Anyone involved in paying for prescription medicines knows the prices can be shocking. Therefore, you can imagine the impact on employer-funded health plans paying on behalf of members. In the current environment, running an Rx audit routinely makes excellent sense. New medicines come on the market yearly as others go off-patent and…

The ever-higher prices for new medications make news continually large employers self-funding employee benefits often bear the brunt. Therefore, running an Rx audit frequently makes sense to double-check claims paid. More than a few high-priced on-patent medications offer rebates and discounts to volume buyers, and audits help confirm your plan is credited. Today,…

Everyone knows auditing is a numbers game, but medical claim auditors double-check additional factors in the healthcare world. They look for coding errors, duplicate services, and other mistakes that add needless costs without improving member service. The game has changed since more powerful software ushered in an era of 100 percent reviews. It was a leap…

The pricing structure for the pharmaceuticals paid for by employer-sponsored health plans often includes rebates and discounts. They can be deducted from the prices paid or credited later. In either case, tracking them across thousands of transactions is challenging, and an Rx audit can help. With their sophisticated systems, claim…

The prospects for financial gain are good when you schedule a healthcare audit of your company-funded medical plan. Claim audits often recover as much as four times their price in the mistakes and overpayments they flag. In the early days of such reviews, they were scheduled as a regulatory and compliance function. However, as audit software and systems have…

Most employer-funded benefit plans audit themselves annually, if not more often, given the value of a claim review. If you're in-house managing a plan and are thinking of scheduling a healthcare audit, do it sooner than later. One of the best times is shortly before you plan and budget for next year. In addition to flagging recoverable…