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 … Read more
Now that self-insured companies are beyond the open enrollment period and wrapping up the fiscal year-end, it’s a perfect time to look for places to save money in 2019. Second only to payroll, healthcare expenditures constitute the largest line item expenditure to companies, so why not start there? Did you know that errors in claims … 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
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
Each year, self-insured employers pour a great deal of time and energy into creating the best benefit plan for their employees. They carefully review and compare benefit packages, consider costs and expectations, enroll employees, and communicate changes. If you have been part of the process, you may feel like it is time to put it … Read more
Interviewer: Randy King is the president of Healthcare Horizons Consulting Group. Randy, what is Healthcare Horizons and why do organizations choose your firm to help them? Randy King: At Healthcare Horizons, we focus exclusively on providing healthcare claim audits for self-insured employers. Self-insured employers are directly at risk for their medical dollars. For example, when … Read more
Mistakes are part of daily life – including the life of a business. Human error is inevitable, and most day-to-day mistakes do not end up costing much in the long run. In many cases, mistakes can teach valuable, long-term lessons at little cost. However, in some cases, simple, unintended errors end up costing a tremendous … Read more