Get Meaningful Savings from a Claim Audit

[TFGPartners]

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 grown more accurate and sophisticated, claim reviews have happened more frequently. Plan sponsors, typically large corporate and nonprofit employers, now understand the potential savings. Double-checking every claim paid gives a clear picture.

Claim auditing continues to increase in value for three reasons. The first is significant improvements in software and systems. As they become more advanced, all claims can be reviewed to an impressive level of detail. Second, medical billing becomes more complex every year, and checking claim payments is crucial because the number of places where mistakes can be made often increases. Third, prices continue to skyrocket in the healthcare area. As costs rise, so does the total expenditure. Therefore, the sums of money involved grow every year. So, it makes more sense to audit than ever before.

Not all audit firms are alike; finding one specializing in claim reviews is beneficial. Because it's their entire business, you can expect better systems and methods. They also have more profound knowledge and expertise in medical billing, which is complex. Checking medical and pharmacy claims is unlike conventional numbers-driven auditing. While there is a financial component to it, the key to accuracy lies in understanding the services being provided. For example, some tests that add cost are duplicates of each other and need not be administered together. That knowledge helps your plan.

Sudden unexpected increases in medical and prescription medicine costs can wreak havoc on budgets and hit the bottom line hard in for-profit enterprises. Experienced claims reviewers can report trends and data related to your cost increase that help you understand them better. It's also interesting to compare auditors' reports with those from your third-party medical claim administrator and pharmacy benefit manager. If everything agrees, then it confirms things are working correctly. But if not, you have the basis for further investigation and oversight to understand better what can be corrected.

Company Name- TFG Partners, LLC

Address- 437 Grant St #1020, Pittsburgh, PA 15219

Contact Number:(412)-281-2228