The Trends Driving Medical Claim Auditing Today

Posted on 1 September, 2023 by TFGPartners

When you examine the work of healthcare auditing companies today, you'll find they are continuously improving their claim review services. Much of it is thanks to ever more accurate software and systems. But humans are behind much of the advance, and the dual expertise of claim auditors is driving much of the improvement – their audit skills combined with a knowledge of medical billing., Both are complex and needed for the most accurate claim audits. The goal is to capture as much of the required data electronically as possible so that the results come more quickly and with less human review required.

Audit setup is often the key to accuracy. Every plan has unique provisions that must be understood and loaded into the system. You'll find more errors when the setup is correct and the review process becomes more accurate. With claim administrators driving error rates into the low single digits, the need for precisions in auditing is obvious. It requires a robust system to find mistakes buried in data and have eluded processors. Still, there are significant opportunities for every plan to catch past mistakes and prevent future ones. It adds to better plan management in the long run.

If you're interested in the history of claim audits auditing as well as the trends driving it today, it goes back to random sampling. Initially, it was the only available method, and until 100 percent reviews came along later, it was the only possibility. Large repeating error patterns were sometimes detected in a random sample, but individual errors, some quite costly, eluded the audit findings. It all changed with systems and software that leaped ahead and could begin reviewing every claim. Since then, accuracy has steadily climbed, and the financial value of claim auditing has steadily increased.

The coronavirus pandemic sent shock waves through many health plans with unprecedented costs. As a result, some have elected auditors to monitor their claim payments continuously and report the findings monthly. It's the best way to manage plans and conduct oversight. Finding claim payment errors in real-time and submitting them for reimbursement is the easiest and most direct way to get repayment. It makes the case for reviewing claims frequently and having an auditor flag any errors. You can also directly compare the auditor's findings with any reported by your claim processor.

Company Name -TFG Partners, LLC

Address- 437 Grant St #1020, Pittsburgh, PA 15219

Contact Number: (412)-281-2228