Are self-insured CEOs asking the right questions of their benefits managers when it comes to healthcare spending? Do they even know that there are crucial questions to be asked?
Every year, millions of dollars in overpaid healthcare claims are funded in error by self-insured employers. Asking the right questions can help ensure that those dollars paid in error can be recovered and returned to an organization’s bottom line.
What are the right questions self-insured employers should be asking?
- Who audits our claims payer (TPA)?
As a self-insured employer, the TPA processing your claims is paying out your money, after all. Who will find the financial errors that can range, on average, from 1 to 3 percent of your total claims, a cost that self-insured employers are funding from their own pockets? Internal audit processes typically review a few high-dollar or randomly selected claims. It is nearly impossible for random sample audits to uncover systemic issues that can lead to future errors in claims payments. Best practices call for third party audits of your healthcare claims, not the broker (who does not specialize in comprehensive claims auditing) and not the TPA (who has no financial incentive to ensure payments are correct). - Why aren’t we auditing every claim versus a random sample?
The administrative services agreement between the self-insured employer and their payer often limits the scope of healthcare claims audits. Payers often limit the audit ability of the employer to only random sample audits. Employers should demand the right to review 100% of their claims payments. Random sample auditing will not uncover all of the errors that are potentially present, which can leave hundreds of thousands of recoverable dollars on the table. Benefits managers can and should renegotiate contracts so the employer’s financial interests are protected. It’s your fiduciary responsibility to your stakeholders. - How are your benefits managers helping you avoid surprise bills?
When your employee seeks medical care, if he or she inadvertently uses an out-of-network provider, the financial impact can be significant to both employer and employee. This often happens in the case of air ambulance services. A hospital or emergency crew may call for air transport, and the patient has no choice of a service provider. Later, the self-insured employer and the employee are hit with staggering “surprise bills.” Does your benefits manager have a process in place for negotiating with providers like air ambulance services to ensure that bills are fair?
Regular audits and negotiation of high-dollar out-of-network fees by a trusted company like Healthcare Horizons can help self-insured employers contain costs and return formerly “lost” dollars to their bottom lines. Cure the Benefits Blues by performing an annual, 100% Difference comprehensive audit on healthcare claims, which can uncover thousands of dollars (or more) that can be recovered for the self-funded employer.
The Difference is in Knowing.
To learn more about our approach to healthcare claims auditing or provider fee negotiation services, visit Healthcare Horizons or contact us at hhadmin@healthcarehorizons.com.