Like anything else, there are differences among medical claim auditors, and their expertise and accuracy have much to do with the value of your next audit. With employer-funded health and pharmacy plans increasingly conducting oversight of claim administrators, the role of audits is unquestioned. If warranted, finding irregularities and recovering overpayments can improve your plan’s financial performance and member service. Because auditors today review 100 percent of claims, the opportunities are more significant than before. It also helps to catch mistakes soon after they are made.
Audit setup has much to do with accuracy, and it’s a combination of your plan’s one-of-a-kind provisions and the auditor’s general knowledge of the field. One of the cases to be made for using a specialist claim audit firm versus a large generalist one is their daily immersion. Smaller firms that are totally focused on claim reviews are familiar with the systems of all significant processors and error trends they have discovered. There is no substitute for such experience; they can “hit the ground running” with your audit. You’ll see more significant results if you establish a working relationship and they audit your payments routinely.
Medical billing and coding are complex, so claim administrators work in an area where mistakes are possible, even though they make performance guarantees. Their self-reporting is valuable, but having an independent auditor’s report to compare the data against is enlightening. Even the highest quality processors make errors, and finding and correcting them is an opportunity. As healthcare costs continue to skyrocket, claim audits can quickly become contributors to the bottom line rather than expense items. Your plan members also benefit and are treated more fairly when claims are paid accurately.
Each audit firm maintains a proprietary system and adapts software to its unique needs. As a result, there is variation among methods and the accuracy they can promise. The foundation of auditing is numbers-driven, but medical claims require additional knowledge. Many specialist auditors have people on staff with medical billing and claim payment experience, making them uniquely qualified to provide a more accurate and thorough service. Reporting also matters; finding a firm with clean and easy-to-use reports helps increase their value. You need the data for oversight meetings with administrators.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228