Skyrocketing health care costs and the recent coronavirus pandemic have put financial pressure on self-funded health plans as never before. As a result, medical claims auditing companies are being called on to help. One way they can is with a continuous monitoring service that reviews every claim paid. It helps in-house plan managers be sure that claims administration is accurate and following the established parameters. During times of higher demand and a novel illness like COVID-19, the chance for mistakes and overpayments increases exponentially. Finding and reporting errors in real-time makes a difference.
Tracking and reviewing charges related to coronavirus testing and treatment has become a priority for every health plan because the horror stories about overcharges are legendary. They range from surprise billing for testing to newer treatments and telehealth visits. They include surprise billing for testing, treatment, and telehealth visits. Among the recent headline-grabbing overcharges are $10,000+ billings for routine tests customarily billed for $8. With amounts like these happening, increased monitoring vigilance is imperative. Waiting for an audit and trying to recover funds is more complicated.
Monitoring continuously is a service that's increasingly recommended and gaining in popularity for obvious reasons. With high costs on the line and numerous variables that can affect corporate and organizational bottom lines, keeping a close watch on claim payments is essential. Real-time monitoring is an outstanding management tool for mid- and large size companies with self-funded health plans. It takes advantage of today's more sophisticated audit software and reviews 100-percent of claims shortly after they are paid. Irregularities and mistakes are caught quickly and never become large problems.
Today's higher expectations for excellent management practices, often driven by technology, look favorably on closer oversight of claim payments. Identifying and correcting errors early in the process is a priority and keeps plans better managed. The continuous monitoring provided by more advanced auditing firms accomplishes it in a budget-neutral or better way with very little time commitment for in-house staff. As 100-percent of claims are reviewed, there is a detailed report on plan performance available at all times. Future audits are no longer time-consuming nor stressful.
