Offering employee medical coverage is a significant expense for companies. The potential financial exposure is considerable for those sponsoring plans, which is why more businesses are focusing on tighter plan management. Medical claims auditors and their firms provide various services that go beyond the basic compliance with ERISA and Sarbanes-Oxley regulations and state laws. Many companies opt for comprehensive claim audits instead of random sampling and incorporate continuous claim monitoring into their strategies. It provides needed oversite and factual data.
Accuracy is crucial in medical claim payments, enabling companies to manage costs effectively and better serve their employees. The advancements in audit software that began in the 1990s and continue to evolve today allow for precise reviews of every claim processed under a self-funded plan. Plan managers who have experienced the transition from random sampling to full claim audits are often impressed by the enhanced accuracy and reduced workload for in-house teams. The detailed reports and data from these thorough audits are valuable tools for effective plan management.
Real-time claims reviews, called continuous claims monitoring, represent a significant advancement in managing self-funded health plans. This approach serves as a powerful mechanism for oversight and plan administration. Reviewing claim payments shortly after they are made can quickly identify and rectify discrepancies and overpayments. This proactive monitoring helps prevent large-scale errors that could dramatically inflate plan costs. Without this oversight, identifying and addressing the root causes of such issues becomes much more difficult.
As companies face increased scrutiny over their cost centers, particularly in the wake of challenges like the coronavirus pandemic, there is a growing emphasis on tighter plan management. Meanwhile, employees have heightened expectations for the medical services they receive. This creates a balancing act for in-house plan managers who must navigate the demands for cost control alongside the need for enhanced service delivery. Utilizing advanced software and the services of claims auditing firms for ongoing monitoring can help organizations meet today’s elevated standards of performance.
