Thanks for taking the time to visit the new Healthcare Horizons website, and for pausing to read On the Horizon. In this space, we hope to offer observations, guidance, and insights for a landscape that is increasingly complex and confusing.
One of our core values is a focus on relationships with our clients. Our interest is in helping clients succeed today and in the future. Because of this, we are particularly sensitive to and experienced in understanding the relationships between our clients and their third-party administrators (TPAs).
In our work with self-insured employers, we often hear that companies may not understand the need for an audit of their healthcare claims, or that they are apprehensive that an audit might negatively affect the relationship with the TPA.
This reminds me a little of using a credit card to pay for travel, but not checking your statement every month to ensure that all of the charges are accurate. You trust your credit card company to pay the airlines and hotels for services, but what if the hotel bills you for an extra room night when you checked out early? Perhaps the airline charges you for 10 checked bags instead of one? In a worst-case scenario, what if fraudulent or unauthorized charges appear on your statement as a result of theft?
In most of these cases, if the errors are undetected, you pay the bill, and the credit card company receives the commission its due from the retailer.
The good news is that most of us review our credit card statements each month before making those payments to ensure the charges are not fraudulent and that we actually made the purchases for which we are charged. Furthermore, we likely do not look at only one or two of the charges; we review all of them.
That is exactly what we do with a comprehensive claims audit. Using our proprietary algorithms, we analyze every claim funded by our clients to ensure it was accurate and consistent with the plan design. We also use the analysis to identify systemic issues, so we can prevent future errors for our clients. And, we do all of this with an eye toward a smooth client-TPA relationship for the long-term.
In this space, we will be sharing more thoughts on the importance of audits, and the different types of audits. In the meantime, if this sounds like the kind of reassurance you would be interested in, we would like to start a conversation.