Benefits brokers are trade professionals.
Just like any other profession, we count on them to provide expertise in addressing our problems. In healthcare, benefits brokers have tools that can save self-funded companies money on their health plans.
General Contractors for Health Insurance Plans
Think of benefits brokers as a general contractor for your self-funded health insurance plan. If you are renovating your home, you most likely will hire a general contractor to oversee the project. The contractor does not have all of the tools for a kitchen repair. Instead, they call a plumber to move water pipes, a flooring specialist recommends the best type of material for the traffic in your space, and an electrician makes sure all wiring is up to code. You want someone experienced in each area to make sure the project is done correctly and with the best return on investment.
Your self-funded insurance plan deserves the same treatment. A benefits broker has numerous tools to contain the costs of your plan, saving the company and employees money.
Benefits Brokers Tool: Claims Audits
One of these tools is a comprehensive claims audit. We partner with benefits consultants and brokers to provide this tool. Comprehensive claims audits discover and recover overpaid monies and identify systemic errors that can cost companies hundreds of thousands of dollars or more!
All audits are not created equal! What to look for in a healthcare claims audit process:
- Comprehensive Audits vs. Random Sampling. All healthcare claims data sets have errors. Do you really want to leave finding those errors to “chance?” That is exactly what a random sample audit does – eliminates the auditor expertise in finding errors – for a luck of the draw. Our comprehensive process ensures every claim is analyzed for potential error.
- Internal Audits. TPAs will sometimes perform limited internal audits for their self-insured clients. This is like the fox guarding the hen house! External audits are a best practice for satisfying the employer’s fiduciary responsibility.
- Realistic Time Frames. Many TPAs limit the number of times the plan can be audited as well as the length of the look back period for recovery on overpaid claims. Annual audits avoid the “too old to recover” claims.
Cause the Effect
For Human Resources leaders heading to the SHRM conference in June, you’ll recognize this phrase as the theme of the event. Incorporating audits into your overall healthcare plan is a direct action that leads to a positive effect. Ask your benefits broker if audits are included in the recommendations they are providing. If not, ask them to contact us. This is a must-have tool! Be sure to carefully review the audit rights in the administrative services only (ASO) agreement with your third-party administrator. Have more questions? Stop by SHRM Booth #2870 and we can talk through your current situation and show you how we can help bring cost-savings to your company’s bottom line.
A Win-Win Tool
If, as a broker, you are not offering this tool to your clients, let’s talk! Providing audits is a win-win. Clients look to their benefits brokers and consultants to help save the company and their employees money. Company benefits coordinators and human resources leaders should be a bottom-line contributor for their companies! Make sure you are using every tool available to you to help them. As the health insurance professional, you are the general contractor in charge of the overall health plan for your client. Let’s partner to make you a winner!
For more details on how audits bring value to brokers and their clients, read “4 Claim Audit Benefits for Self-Insured Clients.”