Now that self-insured companies are beyond the open enrollment period and wrapping up the fiscal year-end, it’s a perfect time to look for places to save money in 2019. Second only to payroll, healthcare expenditures constitute the largest line item expenditure to companies, so why not start there?
Did you know that errors in claims payments can range from 1 to 3 percent of total claims, a cost that self-insured employers must cover out of their own pockets? Performing an annual healthcare claims audit can save thousands, possibly millions, of dollars for a company and makes HR a bottom-line contributor.
However, choosing the right audit firm and working with the right people can make a huge difference in how much money you are able to recover. To execute a successful Request for Proposal (RFP) process, HR must know the answers to several questions.
Know Your Audit Rights
First, review and understand your audit rights so you can negotiate the best possible agreement for your company. Some questions to ask include:
- Can we perform comprehensive versus random sample audits?
- Are contingency priced audits allowed?
- How many claims can be reviewed during the on-site visit?
- What audit period is allowed?
- Does the TPA allow for an annual audit?
Know Your Auditor
When selecting an audit partner, it is important to know what sets them apart from their competitors so you can make the best decision for your company. Some questions to ask include:
- What is the level of expertise and experience of the claims audit firm with the TPA?
- Does the claims audit firm identify systemic errors and make root-cause recommendations to keep costs down?
- What are the HIPAA practices and compliance of the claims auditing firm?
- What is the expected timeline of the project?
- What categories does the audit firm review?
- Who decides which claims get recovered?
- Who monitors collections?
- Does the claims audit firm negotiate direct credits or settlements from the TPA for you?
The RFP process is crucial to finding a trusted, people-centered healthcare claims auditor who will return the most money to your bottom line. Claims auditing allows HR to make a significant bottom-line contribution to the company on its second largest line item expenditure.
To learn more about executing a successful RFP, check out our brief white paper,
Getting the Most from the RFP Process. (See our broker version here.)
The Difference is in Knowing.
To learn more about our approach to healthcare claims auditing, visit Healthcare Horizons or contact us at hhadmin@healthcarehorizons.com to discuss a free healthcare claims audit assessment.
Randy King is president of Healthcare Horizons Consulting Group, Inc., which has performed healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.