Managing the continuous rise in healthcare costs remains challenging for every health plan. Therefore, it's important for plan sponsors to recognize the benefits of running a medical and Rx audit to double-check claim payment accuracy. With technological advancements, claims can now be reviewed for accuracy and compliance with the specific plan provisions. It offers an opportunity for cost containment, as even small percentages of mistakes can accumulate. Unlike in the past, where recovering mistakes typically required a random sample audit, today, assessing every single claim is standard practice.
One of the critical benefits of auditing is the oversight it provides over external claim administrators. Since they handle claims in large volumes, errors can happen even with the best administrators. They might also overlook mistakes made by medical providers in coding invoices and other technical details. The thoroughness of an auditor's report, highlighting every discrepancy, can be quite impressive. Utilizing sophisticated software for electronic claim reviews yields remarkable results and allows for real-time monitoring of claim payments. Picture receiving monthly reports filled with factual insights.
For larger employers sponsoring health and pharmacy benefit plans, audit reports serve as a valuable tool for budgeting. A deeper understanding of claim payments and their accurate administration contributes to more precise budgeting. Additionally, conducting frequent audits can help identify emerging trends, allowing for proactive management before those trends escalate into bigger issues. The importance of such reviews was particularly evident during the soaring costs and utilization rates seen during the coronavirus pandemic, where assessing every claim proved invaluable. Audit reports can also be cross-referenced with those from claim administrators to clarify expenses further.
Establishing a long-term relationship with auditors who conduct regular audits brings several advantages for health plans. It allows for comparing current and past data and fosters a deeper understanding of claim payments over time. This ongoing tracking of thousands of details can reveal significant trends and expenses. Moreover, the insights gained from claim audits can assist in planning and ensuring equitable treatment for all members. By identifying billing errors made by providers, auditors can help prevent unnecessary costs that could amount to thousands, facilitating corrections and avoiding future mistakes.
