Is Your Company Health Plan Ready for a 100-Percent Audit?
In the increasingly sophisticated world of facility claims auditing, 100-percent audits are the method of choice and are accompanied by a multi-part process. Comprehensive auditing of self-funded medical plans gives a complete report on how the plan is functioning – and how the claims administrator performs. Given the high stakes of skyrocketing medical costs and ever-tighter corporate bottom lines, companies today must have airtight claim administration. Problems must be caught and corrected quickly, ideally with continuous monitoring following an audit. The combination is more effective.
Today's top benefits auditors operate with highly sophisticated proprietary software that can detect even small problems in their early stages. Its efficiency reduces the time demands on a company's in-house benefits staff while correcting errors and suggesting systemic improvements. It's nothing like the prior random sample methods and has helped usher in a new era of accuracy in facility claims auditing. When continuous monitoring is added, plans have data and reports about claim payment in near real-time. It allows oversight of third-party administrators that was not possible before.
Thorough audits include a close review of plan documents and provisions. Records covered include summary plan descriptions, employee benefits handbooks, and administrator service agreements. A complete audit will consider all of these when reviewing claim payments and the administrator's accuracy and performance. The most effective benefit plan audits drill down into the details deeply. It's only when everything is factored in that every possible irregularity or mistake is caught. The items range from overpayments on individual claims to larger systemic issues that, when corrected, yield more considerable savings – and greater plan efficiency. Effective auditors may suggest a range of system improvements.
Actionable and easy to understanding reporting is a crucial feature of the most effective plan audits. There is also a human review and analysis of the electronic audit findings that brings the final audit quality up to much higher standards. It's where suggestions for system improvements and solutions to existing problems are developed and finalized. Most of these services are budget neutral and commonly identify and correct errors greater in value than the cost of the service., It's why companies today audit and monitor far more than government regulations require – and their plans function better because of it.
