If you are like most people, you sometimes deal with complicated relationships. The demise of a partnership often comes down to a lack of communication, especially about sensitive issues. Facing Relationship Reality head-on takes courage when we would rather just stick our heads in the sand! However, if you want your relationships to thrive … it’s time to get real.
For most couples, one partner is the designated “financial” manager, responsible for paying bills, reviewing bank statements and generally overseeing the finances. The other partner trusts that every detail is being handled for the good of the relationship. But people make mistakes. We all do. And inevitably, most of us have had or will have arguments over money.
What If …
If you are handing the reins over to your partner, you want to know they have the expertise and are watching every penny on your behalf. You want to know you can trust them to look out for your best interests and catch any errors that may be costing you unnecessarily. And likely, you assume that is exactly what they are doing. But what if they aren’t that detailed and are just randomly selecting items here and there to review?
When self-insured employers hand over their healthcare claims to a TPA to manage, they are trusting a partner to handle what can often be the largest business expenditure they have after payroll. The sheer volume of claims handled by a TPA can be massive, and people do make mistakes!
Whose Fiduciary Responsibility Is It?
It is the employer’s fiduciary responsibility, not the TPA’s, to keep an eye on the mistakes that will and do happen. Up to 3 percent of claims can contain errors, a cost that self-insured employers must cover out of their own pockets. The only way to know for certain that all claims are paid properly, or that your plan is being administered according to plan intent, is to conduct an annual audit. The best way to combat errors is with the Healthcare Horizons 100% Difference comprehensive audit, where we look at every claim. Not only can we identify one-off errors, but we can ensure that root-cause errors are identified and corrected. The recovery of overpaid claims is added back to your bottom line.
In relationships, as in business, the more you know, the better decisions you can make. Staying on top of errors through a comprehensive annual audit ensures everyone wins – your company, your employees and your stakeholders – and that leads to more happily-ever-afters.
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.