Audit Your Company Medical Plan and Stay on Budget

TFG Partners is a healthcare claims audit and monitoring firm that has been leading the industry for nearly 30 years.

There are regulatory requirements and sound financial reasons to audit a self-funded corporate medical plan. Companies have promised employees who are plan members excellent care, and the costs can be significant. It's why high-caliber health plan audits are an increasingly essential tool for plan managers. With today's 100-percent methods, all claims are reviewed rather than the past practice of spot-checking with random samples. More than a few administrators have been surprised to find out that medical plan audits are revenue neutral – or recover more in savings than the audit fee.

Advances in technology at some of the best claims auditing firms have enabled the 100-percent method to grow in popularity. Because each claim carries the potential for a mistake, random sample audits overlooked many things that can be caught and corrected today. It has transformed the process and now detects small, individual errors as well as larger systemic problems. For plan managers who oversee claims administration by outside health plans, the arrival of consistent and comprehensive data has been a revelation. There is far less room for disagreement when the facts are presented in detail.

Claim audits also meet regulatory requirements as they improve plan performance. The corrected errors can be prevented in the future, which means the benefits of an audit are long-lasting. Because of budget neutrality, more companies are auditing routinely. The results are as much a cost-effective management tool as they are a report for regulatory compliance. Auditors using a 100-percent method are increasingly in favor because of greater accuracy. They pick up irregularities at a higher rate and can report back to plan managers with useful data. It leads to better management and greater accuracy.

Increasingly, claims auditing is viewed as a strategic management consulting function rather than an occasional practice for regulatory compliance. It adds value while remaining budget neutral. Employees who are members are better served when claims as administered in a manner consistent with the plan's summary description. It also ensures fairness so that everyone is treated equally, regardless of the provider they see. The old random sampling method can't come close to the precision of a 100-percent claims audit -- and when you monitor continuously, the results are even better in the long run.

TFG Partners

5 Blog posts