Podcast

November ushers in two things: the grateful season and a flurry of year-end activity. We are thankful for many things this past year, all of which have a part in helping shape portions of the healthcare industry into a more accurate and less wasteful system.

• The return to in-person events, from conferences like SHRM to leadership presentations, allowed us to reconnect with new and old friends.
• We saw new legislation that made the healthcare industry more transparent, better protecting all participants, including
  • the “No Surprises” bill that ensures consumers know how much procedures will cost and
    eliminates balance billing for out-of-network ambulance service, and
  • the mandated inclusion of fees paid to suppliers and conduits so that employers can
    objectively evaluate the best healthcare plan for their situation.
• Our team has worked exceptionally hard to provide even better service to our expanding client base.
• Partners, like benefits brokers and human resources managers, have been supportive of our initiatives and acted as true ambassadors to decision-makers to see the importance and value of medical claims audits.

And of course, we are most thankful for our clients. The relationships we develop through our unique comprehensive audit process allow us to interact with so many wonderful individuals and companies. These relationships make our job more rewarding and allow us to provide even better results because of the belief in our system.

Grateful but Busy

While we would all like to slow down for the holiday season and simply count our blessings, the end of the year also means deadlines. From a healthcare perspective, patients are trying to squeeze in last-minute appointments to use any benefits that expire on December 31. Most practitioners are doing their best to accommodate as many people as possible. However, increased volume and tight deadlines are a bad combination and can lead to administrative errors. It is important to have a review process in place to ensure the claims made through a healthcare plan are filed accurately. Specifically, medical claims audits can find overpayments that can save an employer-funded plan thousands of dollars. (For an overview of how overpayments impact both a company and the employees, read more here.)

Another deadline to be aware of as it pertains to healthcare claims is the statute of limitations for evaluating claims and seeking reimbursement for any overpayment. Most plans have a set time frame for claims to be reviewed, often 18 or 24 months. Most claims reviewed outside of this limit will not be eligible for corrective action. So, if many more claims are filed leading up to December 31, the deadline for reviewing a large number of claims is also coming up. If between one and three percent of claims under normal circumstances have inaccuracies, that is a significant number of potential overpaid claims and corresponding dollars that your self-funded healthcare plan could miss recovering.

We wish everyone a season of gratitude. We hope you enjoy time with family and friends, count many blessings, and rejuvenate for the upcoming new year. As you look forward to next year, we welcome the opportunity to help your company provide better benefits for employees through medical claims cost savings. That is something everyone would be grateful to see!

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers, involving all national and most regional payers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers.