Corporate self-funded medical plans have recently been under enormous financial pressure with skyrocketing healthcare costs and a once-in-a-century pandemic. While both of these have occurred, lockdowns have hurt sales for many companies and reduced their earnings. Therefore, it's not hard to see why medical claims reviews with advanced auditing techniques have become essential. Finding errors and overpayments and recovering the funds connected to them helps plans serve members and protect the bottom line. Many companies begin to monitor claim payments continuously after an audit.
Auditing and monitoring can help plant managers deal with new issues that have arisen since COVID-19. They include surprise billing for testing, treatment, and telehealth visits. There is also the need to check up on new rules such as co-pay waivers for some coronavirus treatments. Most plan managers also want to be vigilant after hearing horror stores about $10,000+ billings for routine tests that are often billed for $8. It's given claim processing oversight an urgency that has not been present earlier. With senior management and shareholders on edge about overall performance, health plans must perform well.
The world's foremost claim auditors are ready to help with a wide range of plan management tools for large- and mid-size companies that self-fund health care. The one gaining traction most is continuous claim processing monitoring. It has advantages over audits because it catches errors in real-time and points to system improvements before problems become more extensive. It's an excellent management tool for in-house plan managers and allows for easy oversight of processors. All claim administrators will make promises about the accuracy, but nothing substitutes for double-checking. Companies need the capability.
Effective management practices always call for oversight and catching errors while they are small and before they multiply. It's a crucial budget management technique for all self-funded employee benefits plans, mostly medical and pharmacy plans. Continuous monitoring by advanced auditing firms with excellent software and processes can review 100-percent of claims paid in real-time. It produces reports of unmatched accuracy, and lets plan managers watch trends and totals for claim payments. Irregularities become easier to spot, and all problems are caught more quickly.