As Medical Costs Rise, Audit Claims
Overcharges are the tip of the iceberg in medical billing errors that cost millions of dollars annually, underscoring the critical need for comprehensive oversight through medical claim auditing services. These audits serve as a vital safeguard, identifying potential overcharges, recovering incorrect payments, and ensuring equitable treatment for all members. Additionally, they provide invaluable data for negotiating rates with providers and allow for timely adjustments during unexpected events. Health plan auditing is increasingly utilized by large employers that self-fund their plans.
As claim payments have transitioned to third-party processors, audits have become a reliable backstop. While insurance carriers that function as third-party administrators maintain a high degree of accuracy and keep error rates low, the substantial dollar amounts involved make even a small percentage of errors impactful to a sponsor's bottom line. Audits play a crucial role in reviewing claim payments, flagging potential overcharges or…