The surging costs of medical care and medicines and the recent coronavirus pandemic have placed unprecedented financial strains on self-funded health plans. In response, healthcare audit firms are stepping in to assist. One effective approach is their continuous monitoring service, which scrutinizes every processed claim. This ensures that in-house plan managers can verify the accuracy of claims administration and adherence to established guidelines. During periods of high demand and with new challenges like COVID-19, the likelihood of errors and overpayments can skyrocket.
It is crucial to catch and report these mistakes in real-time. Monitoring expenses related to COVID-19 testing and treatment has now become a top priority for all health plans, especially given the notorious instances of overcharging. These issues have included unexpected bills for testing, advanced treatments, and telehealth consultations, with some outrageous cases featuring charges over $10,000 for tests typically billed at just $8. With such staggering discrepancies, there is a clear need for heightened monitoring; relying solely on post-audit recovery is more complicated and time consuming.
The push for continuous monitoring services is growing and becoming increasingly recognized for its benefits. With substantial costs at stake and many factors influencing organizations’ financial health, vigilant tracking of claim payments is vital. Real-time monitoring is an exceptional resource for mid- to large-sized companies with self-funded health plans. It utilizes advanced auditing software to review 100% of claims shortly after they are processed, allowing for quick detection of irregularities before they escalate into more significant issues. Working closer to real-time always yields better results.
Today’s standards for effective management practices, often influenced by technological advancements, favor enhanced oversight of claim payments. Early identification and correction of errors are paramount for maintaining efficient plan management. The ongoing monitoring provided by leading auditing firms can be achieved in a budget-friendly manner, requiring minimal time from in-house personnel. Since every claim is reviewed, detailed reports on plan performance are readily available. Consequently, future audits become less time-consuming and stressful thank to newer continuous review methods.