Check with seller Medical and Rx Claim Audit Fundamentals Philadelphia

It’s crucial to maintain oversight when dealing with significant cash outflows such as medical and ******cy claims. One effective way to ensure accuracy in claim payments is through healthcare audit services. Mistakes can occur due to electronic and human error, and the costs can be substantial even with low error rates. Conducting regular audits can help identify irregularities, leading to recoveries and system improvements to prevent future errors. Claim audits have evolved from being primarily focused on regulatory compliance to becoming valuable plan management tools over the years.

Large employer-funded health plans have specific provisions, and claim processors must align their systems with these provisions. Given the complexity, oversights are nearly inevitable, and audits are crucial in identifying and reporting them. Effective auditors invest time setting up systems to thoroughly examine numerous data points on each claim, unlike older audits that rely on random sampling. They employ a comprehensive approach with minimal drawbacks. Well-managed plans prioritize their fiduciary responsibilities by consistently paying claims accurately and treating all members equally.

Establishing a long-term audit relationship with your auditor can be highly beneficial. Periodic reviews using the same system allow for direct comparisons of past and present results, offering a precise comparison of improvements or areas requiring attention. As auditors gain insight into your claim administration and plan provisions, they can focus on addressing frequent concerns, ultimately enhancing accuracy and reliability. Audit set ups are among the most important parts of the process. They facilitate customization what considers your plan’s unique provisions and checks against them.

Today’s claim audits are characterized by their speed and efficiency. Advanced systems can review thousands or even millions of claims in a fraction of the time it used to take. It means checking thousands of data points across thousands (or millions) of claims. Rapidly identifying error patterns and single errors provides the opportunity for potential recovery. Furthermore, the cost of these services is usually significantly lower than the value of recoveries, making claim audits a valuable investment that contributes positively to the bottom line. They’re a valuable toll that contributes to your bottom line.

Contact seller Share