renewable-expert

Corporate self-funded medical plans face significant financial challenges due to soaring healthcare costs and the impacts of a global pandemic. As many companies have experienced decreased sales and earnings due to lockdowns, it becomes clear why healthcare audit services using advanced auditing methods are crucial. Identifying errors and overpayments and recovering related funds helps plans better serve their members and safeguards their financial stability. Consequently, many organizations have begun to implement continuous monitoring of claim payments after conducting audits. 

Auditing and monitoring processes enable plan managers to address new challenges contoinually emerging. Some date to the pandemic such as billing for testing, treatment, and telehealth services and the need to stay updated on new regulations. Additionally, plan managers are becoming more cautious after hearing alarming accounts of exorbitant bills, sometimes exceeding $10,000, for routine tests that can cost as little as $8. This urgency has made claims processing oversight more critical than ever, especially with senior management and shareholders increasingly anxious about overall performance. 

Leading claim auditors are equipped to provide various plan management solutions for large and mid-sized companies that self-fund their healthcare. One method gaining popularity is continuous claims processing monitoring, which offers distinct advantages over traditional audits by detecting real-time errors and identifying opportunities for system enhancements before issues escalate. This tool is invaluable for in-house plan managers, facilitating effective oversight of claim processors. While all claim administrators tout their accuracy, nothing can replace the necessity of independent verification. 

Implementing effective management strategies requires diligent oversight to catch errors early, preventing them from snowballing into larger issues. This practice is vital for budget management across all self-funded employee benefits plans, particularly in the medical and pharmacy sectors. Continuous monitoring by reputable auditing firms utilizing advanced software and processes can analyze 100% of claims in real time, generating highly accurate reports and enabling plan managers to track trends in claim payments. Such vigilance makes it simpler to identify irregularities and resolve issues promptly.