Annual employee healthcare costs are a significant budgetary line item for corporate and nonprofit employers alike. One approach is to factor in a fixed percentage and hope for the best. Another is to employ methods like medical claim auditing to understand your expenses more clearly. Because most self-funded plans today outsource claim processing, it keeps them one step removed from the data. When auditors analyze every claim paid and develop clear reports about what occurred during the plan year, it helps with budget planning. The more you understand, the better you'll do at forecasting.
When understanding health plan costs, having an audit firm review experience and report on trends is helpful. Picking up cost-increase trends in their infancy, which skilled auditors can do, is insightful. There's also an opportunity when error patterns are flagged and corrected in your processors' system. Fixing them can affect budgeting if they cause cost increases of significance. Overall, plans are better managed when every claim is paid accurately. It can mean less yearly fluctuation in costs during a typical year. If you've had overages except for the recent pandemic, double-checking helps.
When third-party processors solicit your business, they promise to administer claims with low error rates in their processing. They also promise negotiated rates and provider networks your employee members will appreciate. In exchange, they charge fees for their services that promise to reduce your costs and eliminate in-house claim processing costs. There's always the question of accuracy, and an audit provides independent outside verification that promises are kept. If they aren't, you can negotiate based on factual data from the audit report. It puts you in a stronger position when you have the facts.
Besides health plans, pharmacy benefit plans are ripe for expert auditing. Prescriptions should be filled according to formularies and promised discounts applied. Fact-checking the claims can confirm whether everything is happening correctly. With the prices of medicines today, there's every reason to take pharmacy auditing as seriously as medical claim reviews. Together, they can make a significant financial impact. Starting your budgeting process with an audit to examine the current year closely can be enlightening. There's no substitute for having the facts when making your forecasts for the coming year.
Company Name- TFG Partners
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number: (412)-281-2228
