Are You Leaving Money On The Table Without Medical Claim Audits?

When you think about a 99% accuracy rate, it sounds pretty great, right? It’s an A after all. How much damage could that missing one percent really do? It seems pretty measly. But the fact of the matter is, that 1% can make a huge difference. And we’re not talking about finding a few extra bucks. For large companies, this 1% of inaccuracy can mean hundreds of thousands, or even millions of dollars.

What if your interest rate on a loan increased by 1%? Or, what if 1% of your your paycheck suddenly went missing? We’re betting you’d take notice. When it comes to the accuracy of your healthcare administrator, you should take notice too. As a self-funded insurer, it is your money!

Whether you’re a CEO, public sector employee or a benefits consultant, you’re probably asking yourself how you can cover that extra 1%. Don’t leave money on the table that 99% accuracy offers when a simple audit can identify hundreds of thousands of dollars.

For more than 25 years, we’ve conducted audits for countless self-insured firms. We know that it’s not uncommon for a client to have performance guarantees in place of 99% financial accuracy. For example, take a self-funded group that pays $50 million annually in claims. Even a half percent increase of financial accuracy yields $250,000 annually back to the group. Are you willing to leave thousands of dollars on the table ? Probably not. Payment accuracy is critical to a company’s bottom line, and an audit can help you recover some of those missing dollars. At the very least, it will allow you to understand the total value of that 1% and help you negotiate a better contract next time around.

Although, financial accuracy isn’t the only aspect to take into consideration. Our audit approach leaves no stone unturned by bringing in additional elements that ensure every penny from that 1% is accounted for. Our claim audits focus on several aspects instead of only focusing on financial accuracy:

  • Operational Review
  • Targeted Screening
  • Plan Document Review
  • Data Analytics

We focus on these different areas as well as the financial accuracy, and we find opportunities for your TPA to implement changes to further save your plan money. Your organization is constantly striving for quality improvement, and it’s likely that your claims administrator feels the same. To get started with this process, you should set the goal to always examine 100% of claims, and not let that 1% fall through the cracks. This means conducting regular audits to ensure you don’t leave any of your money on the table.

Now that you know exactly what that seemingly small 1% can do, you’ll probably be much more interested in making sure it’s accounted for. No one wants to miss out on that money, especially when that 1% is the small difference between a large amount of money.


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