It’s a Three-Way Tie
Our 2nd annual Lost Benjamin Award voting ended in a three-way tie! The most interesting thing about the winners is that they address each of the fundamental issues we commonly see in healthcare claim errors.
Systemic Errors Add Up
Benefit Errors Cost More Than 7 Million Dollars – Healthcare Horizons
Errors that aren’t caught can multiply and cost your business significant amounts of money in overpaid claims. When the error is a set-up or system issue in the processing of the claims, they are generally referred to as systemic errors. These errors can be small and often go unnoticed. One or two doesn’t seem to be a big deal. However, if the root of the problem isn’t addressed, that “no big deal” will quicky grow to a significant hit to your self-funded health care plan. That’s what happened in this case. Smaller errors went left unchecked for years and added up to a $7 million problem!
Persistent Review of Service Agreements
Seven is a Lucky Number! – Healthcare Horizons
You want to work with an audit company that won’t take no for an answer! With decades of serving clients and decades upon decades of employee experience, we recognize when something isn’t right and know how to fix it. Not only was a keen eye needed to spot this error, but once found, patience and persistence were required. The client’s TPA was convinced a fee included on multiple claims was appropriate as part of their agreement. Except, they couldn’t point out where the fee language originated. We recommend an annual review of your service agreements to make sure all the administrative fees are correctly explained.
Human Errors Can be Costly
Drowning in an Overpaid IV Claim – Healthcare Horizons
Safeguards should be in place to catch mistakes, especially the ones that defy logic. Unfortunately, not only do humans make mistakes, but they also don’t like to admit it when they do! While we aren’t playing the game of gotcha, we are good at finding those errors that make you scratch your head. And when we do, we believe correcting the error as soon as possible is the right thing to do. This winner was a classic example of a mis-entered claim, and the subsequent pushback from the TPA before the overpayment was returned to the client and their bottom line. Thankfully, we were able to outline the mistake and get everyone on the same page.
Sadly, This Isn’t the End
Nominations have started for next year’s awards. We continue to find overpayments in healthcare claims that are costing companies and their employees. You can bookmark the link here so you don’t miss an entry. Do you have an egregious claim error to share? Send your story to hhadmin@healthcarehorizons.com. Even more importantly, be sure you are having your claims reviewed with a comprehensive audit so that you don’t see your error on our award list!
