Ever feel like someone is not telling you the whole truth? Do you wonder if there is something important that you do not know? Most people want to know the real deal, even if it is not pretty. When it comes to the healthcare claims your TPA is paying on your behalf, it is to … Read more
It’s budget season! As self-insured employers prepare budgets for the new year, how nice would it be to find some extra dollars in your second largest expense item next to payroll? Imagine what you could do with more. Most self-insured companies assume that their Third-Party Administrator (TPA) has a zero claims payment error rate, when … Read more
When It’s Your Money, How Much Error is Okay? Your bank called. They have adopted a 1 to 3% acceptable error rate for your account because 100% accuracy is no longer important. Oh, and by the way, they are going to keep the money they mistakenly cost you! Um, what?? This scenario is what you agree to … Read more
The typical (and sometimes contractually required) methodology for healthcare claims auditing features auditors randomly selecting 200 to 300 claims out of millions of transactions. They examine those claims for errors based on predetermined criteria and extrapolate the results across the entire population of claims. This approach may be considered standard practice by your TPA when handling … Read more
What if you were sitting on a potential pile of cash at work, and you didn’t know you were about to lose it? (Ever heard of the two-year no-recovery trap?) Would you want to be caught flat-footed by your boss? According to an article in Forbes, “The Most Important Question a CEO Should Ask their … Read more
BenefitsPro reported in May that Americans’ healthcare costs rose again by 4.5 percent, bringing them to about $28,000 per family. According to 2018 Milliman Medical Index, employers are paying more (3.5 percent), but employees are paying a lot more (5.9 percent). This trend shows a shifting of the healthcare cost burden to employees. As self-insured … Read more
The Difference is in Knowing In 2018, Healthcare Horizons celebrates its 25th year in the healthcare industry. The company specializes in comprehensive healthcare claims audits, designed to identify and correct claims errors that can account for 1 to 3 percent of an employer’s overall healthcare spend. “Many employers choose to self-insure their employees’ medical expenses … Read more
In late 2017, Kmart Corp. agreed to pay $32.3 million to settle a whistleblower lawsuit claiming its pharmacies overcharged federal health care programs and some private insurers for generic prescription drugs. In one case, according to the suit, Kmart sold a 30-day supply of a drug for $5 to customers of its discount program but … Read more
Some organizations are required by law to audit healthcare claims, and unfortunately, some may just select the lowest priced vendor in order to “check the box” and say they did their duty. However, there are other considerations to take into account besides the initial cost of an audit. Vendors who charge less may not truly … Read more
In this Jan. 22 article, “Why Employers Should Care About Medical Billing Errors,” Employee Benefits News magazine takes a look at the impact that billing errors make on employers and employees. Unfortunately, medical billing errors are pervasive in the U.S., and complicated for employers and employees to track. Experts say as many as 80 percent … Read more