Audit Medical Claims Before Budgeting

Posted on 4 October, 2023 by TFGPartners

Budgeting for self-funded medical plans in the post-pandemic era takes on new importance given the recent extraordinary expenses. Before planning for next year, one of the best things to do is look at the results of medical claims auditing. An auditor's report held side-by-side with data from your claim administrator gives the most precise possible picture of expenses. If there are areas you've identified for savings, ensuring that your auditor agrees is wise. Driving down error rates is always a worthy goal and should be pursued, but being realistic about it for budget purposes is wise in the long run. 

Today's audits review 100 percent of claims with unprecedented speed and accuracy. They've become popular with upper management, who need to explain healthcare cost variations to shareholders and others. Factual data allows plans to be managed more closely than ever and confirms utilization trends and other cost-related issues. When third-party administrators know there is routine oversight, they will naturally step up their self-policing. Also, well-managed plans begin with an advantage when extraordinary events such as the pandemic occur. Audits soon after the fact are always helpful.

Finding auditors with medical billing knowledge is your best bet. They know where to look and specialize in the field, so they review claims daily. Developing software and systems that can electronically review thousands of claims quickly and with impressive accuracy is essential. Recent lawsuits by self-funded plan sponsors against their claims administrators are proof the stakes are high – and that routine oversight matters. Some plans monitor their claims payments continuously and monitor costs in real time. Auditing is no longer only a regulatory and compliance function. 

If you have questions that will affect your medical plan budgeting process, ask them in pre-audit meetings. Understanding your needs clearly helps auditors review the areas that matter most. They will analyze claims closely using their knowledge and experience, but you may want to develop extra information in some areas. When you provide insight into your budgeting questions, you'll improve the results you receive. Timing matters, and scheduling an audit several months before your budget planning begins ensures you'll have recent information. You'll appreciate the data when you start planning. 

Company Name- TFG Partners, LLC

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

Contact Number- (412)-281-2228