“Accountability is the glue that ties commitment to the result.” Bob Proctor Are you worried that if claims mistakes are found in your healthcare data set that you will be held responsible? We hear this a lot, but the fact is, NOT finding the mistakes and leaving them uncorrected is what makes individuals or companies … Read more
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 … Read more
Companies that self-fund their healthcare plans have a fiduciary duty to ensure that those plans are being administered properly – even if that administration is done by a third-party administrator (TPA). Your company deserves the same fiscal protection from your TPA that the TPA provides to its fully insured clients. ERISA requires plan sponsors to … Read more
Don’t Let the No Surprises Act Catch You Off Guard! By now, anyone providing healthcare plans as an employee benefit should be aware of the new No Surprises Act, effective at the beginning of 2022. Whether you are the human resources manager tasked with outsourcing this important benefit or the health insurance broker providing options … Read more
Providing Value-Add to Clients Claim audit service is an extra benefit for brokers to present to clients. Audit services can save clients big money over time. There are 4 significant advantages to brokers who include a claim audit service in their proposed recommendations. Healthcare is the largest expense for self-insured employers. They should feel confident … Read more
*This article has been updated to include new information.* Helping Human Resource Leaders become Healthcare Heroes! At the upcoming Society of Human Resource Management (SHRM) conference, Healthcare Horizons will meet with hundreds of individuals tasked with ensuring that a company’s health insurance benefit is a viable option for their employees, without sacrificing coverage to reduce … Read more
Many people often put off filing tax returns until the last minute. They have that nagging anxiety of not knowing – did I overpay and I can look forward to a refund or did I underpay and how much will I owe the IRS? Self-insured employers may approach healthcare claims audits in a similar way, … Read more
Last month, we examined a few of the top categories of claims payment errors. Because every healthcare claims data set has errors — people make mistakes — it is important for self-insured employers to perform an independent, fully comprehensive audit annually to identify errors, correct systemic issues for future savings and recover claims that were … Read more
In this two-part series, we will examine a few of the top categories of claims payment errors. Missing these common errors means that self-insured employers are leaving possibly hundreds of thousands of dollars on the table every year.Rather than asking your employees to contribute more in terms of higher premiums or reducing their benefits, self-insured … Read more
The current practice of “balance billing” allows health care providers to charge the insured employee for the balance of a medical bill when an insurance company does not pay the full amount. Surprise bills can be the result of an insured unknowingly receiving medical services from an out of network provider. These unexpected bills can … Read more