Finding Savings for Your Bottom Line Has No Season
While the end of the year is the time many people evaluate their personal and professional finances, saving money isn’t limited to a calendar date. However, particularly in business, end-of-year financial reviews set the stage for the upcoming budget process. If your company is self-insured, reviewing your employee healthcare plan costs to identify savings should be your number one priority – after all, your company benefits are the second greatest expense behind only employee salaries.
Healthcare Claims Audits are Important for More than Just Savings
The cost of healthcare in the United States is staggering. Health insurance expenditures totaled $3.6 TRILLION in 2018. If you’re one of the 99% of large firms that provide employee health insurance, you’re paying a big part of this tab! There is no indication that this number won’t continue to rise – in fact, some estimates show costs increasing year-over-year by at least 10%. Reviewing the amount paid out against your company’s policy is vital to insuring that neither the company nor the employees are overpaying.
Each year benefits and human resources managers face the important – yet tiring – task of renegotiating health insurance benefits for their self-funded company. What if this year, you were prepared to negotiate for a service that directly impacts your company bottom line by finding big savings? Comprehensive healthcare claims audits are a tool to help you find dollars that can be returned to your company budget. Additionally, these audits ensure you are meeting fiduciary requirements mandated to all insurance providers through the CAA or Consolidated Appropriations Act.
Comprehensive Audits vs Random Sampling
Much like you trust your doctor to run annual blood tests to look for underlying health problems, you can also trust a qualified auditor to review your medical claims each year. These consistent reviews will show inconsistencies, data entry errors and systemic faults in your claims processing. BUT it’s not wise to leave this process to chance. You don’t ask a doctor to only look at your triglyceride counts instead of a full cholesterol panel and you shouldn’t settle for looking at only a portion of the filed claims.
As many as one in ten medical claims have errors! Imagine that you only review five percent of your claims. How can you be expected to recover all of the overpaid dollars? If you only do a random sample audit, you are betting a lot of money that your audit will land on one of the mistakes in your data set. A better option is a comprehensive audit. Our process looks at every claim and identifies those that potentially have errors. Once identified, we work with you – our client – to determine which claims should be pursued for recovery. The best part is that we do all the work and you get the savings!
Recovered Money is the Gift that Keeps on Giving
Everyone has a wish list, especially this time of year. Businesses are no different. Employee benefits are important to attract new hires and for retaining team members. However, they all come at a cost. For every dollar overspent on a healthcare claim from your self-funded policy, that is a dollar lost that could be used for another program. To ensure you aren’t erroneously lining the pockets of a healthcare entity instead of funding initiatives in your business, insist that your TPA include comprehensive medical claims audits in your service agreement. The investment in time (as little as four hours) and money (you pay when we recover) will deliver the best ROI for your company’s bottom line. That is something to celebrate all year!
