As self-funded company medical plans go forward after the coronavirus pandemic and the associated spike in claims, increasing claim payments accuracy is vital. It why medical claim auditing companies that provide the 100-percent review method, which is more accurate than random sampling, are in increasing demand. Their audit reports also trigger less follow-up work for in-house staff and bring more opportunities to root out and correct systemic errors. Each year, better auditors fine-tune their software and methods to bring year-over-year improvements. They help improve claim processing accuracy.
One of the most significant benefits of more accurate medical claims auditing and continuous monitoring is managing a company’s exposure to financial unknowns. Senior management and financial analysts value a well-managed approach that catches errors and irregularities before they become larger problems. Stock prices can be affected when large unexpected medical claim costs suddenly hit the balance sheet. More frequent auditing and monitoring each contributes to closer management – and if unexpectedly high costs occur, to be able to explain their cause and remedy.
The arrival and increasing use of continuous monitoring services has also brought a leap ahead in claim processing oversight. Rather than waiting for audit results, it tracks 100-percent of payments in real-time and reports continuously on plan performance. Errors are spotted as they occur and are corrected before they multiply into significant concerns. The cost is nearly always less than the value of the mistakes it catches, and it’s a benefit to both the plan sponsor and members. Fewer errors mean cost savings and higher member satisfaction rates. The improved results occur as long as monitoring continues.
The value of ongoing monitoring is easily measurable in improved plan performance and is readily justifiable to management. Its presence is also an incentive to claim processors to be more accurate and respect the plan’s intentions. Often audits and monitoring show processors following their generic practices and overlooking a plan’s unique features. With factual data in hand, it is much easier for a company’s benefits staff to conduct oversight and keep claim payments in line. It is also easier to respond to plan performance and cost questions from senior management and finance professionals.
