We're seeing corrections and recoveries for incorrect claims payments for a single beneficiary total in the thousands of dollars much more frequently.
PITTSBURGH (PRWEB) December 02, 2020
TFG Partners, one of the leading corporate medical claims auditors, is being called on to provide secure continuous claims monitoring service to an expanded list of corporate clients. Continuous monitoring is a precise and highly effective management tool for controlling medical, prescription and other benefit plan costs while assuring employee-members are being well-served during times of extreme need.
The global coronavirus pandemic and the current explosion in cases across the United States has the costs of self-funded medical plans changing dramatically -- and it shows no sign of letting up soon. Claims administrators are handling increased volume, including previously unknown and widely varying coronavirus case billings. Many of these administrators are short-staffed staff as a result of COVID-19 themselves. The situation today is creating a perfect storm for errors, overpayments, and out-of-control co-pay and medical claims payments.
"There has never been a time when it's more important for medical plan managers to keep a close eye on their claim payments," observes Pieter van Hoeven, Principal, TFG Partners. "Secure continuous claims monitoring is the way to do it. Continuous monitoring catches errors with a value greater than the cost of the service, and in unprecedented times like these, it often brings far more in savings than it costs." In addition to cost containment, monitoring claims continuously helps plan managers to assure the correct delivery of medical and other benefit services to employees and their dependents.
How Does Secure Continuous Medical Claims Monitoring Work?
What About Security?
Medical claim audit specialists like Pittsburgh-based TFG Partners monitor 100-percent of medical and other benefit claims payments continuously for a wide variety of self-funded corporate plans using proprietary software and auditor reviews of results. It's an appropriate service for any large- or medium-sized company, starting with 1,000 employees and up as they see significant claims volume. TFG checks every claim paid to find and report all errors and irregularities. It produces near real-time data in a format similar to what pharmacy claims auditors find in a medical claims review. Claim payment monitoring helps plan managers root out errors and have administrators correct them before they become significant problems, and result in higher costs/overpayments.
The proprietary claims monitoring software and systems employed by leading specialists like TFG includes multi-layered security protocols. They are carefully designed to protect a company's confidential data de-identifying members' personal information. Security-protection measures include both electronic and physical security and are updated continuously to remain state-of-the-art.
The service is designed to give benefit plan managers complete peace of mind and ensure the focus remains on efficiency and delivery of high-quality, actionable data while keeping information safe.
Medical Plans Need to Closely Review COVID-19 Claims Payments, Errors, Overcharges
Coronavirus testing and treatment is delivered by medical providers ranging from walk-in urgent care clinics to the most advanced hospital intensive care facilities. Some services are very basic, while others involve prolonged hospitalizations. There are well-documented cases of charges for the same test or service varying wildly – from under $50 to well into the thousands. Secure continuous claims monitoring will catch discrepancies like these and enable overpayment recovery in medical billing. It flags any non-standard or questionable payment and allows benefit plan managers to make an immediate review.
Claims administrators independently incorporate generic safeguards into their processing systems, but the only way to know if the systems work specifically for an organization’s plan is to monitor them against the unique plan requirements. It's easy to make a case for monitoring rather than waiting for audits and cleaning up larger messes later on. With costs skyrocketing, companies increasingly monitor benefit claim payments continuously to make sure administrators are delivering on their promises – and doing it continuously. The service also catches errors in prescription plans, from missed discount guarantees and rebates that can quickly cost hundreds of thousands of dollars to plan specific benefit design adherence.Catching and addressing these errors during the course of the year finally assures that plan members, particularly those with high deductible plans are better protected, allows your administrator to improve service pro-actively and results in year-end audits and reconciliations to be handled smoothly without surprises, controversy or extensive need for staff involvement.
All self-funded corporate benefit plans will benefit from monitoring claims payments continuously, but never before has we seen changes that can drive the startling cost-savings results that are likely in the COVID-19 era. "We're seeing corrections and recoveries for incorrect claims payments for a single beneficiary total in the thousands of dollars much more frequently," adds van Hoeven. "We're encouraging all of our audit clients to add continuous monitoring as they want to deliver the benefits their members need while maintaining better costs control in this unprecedented situation."
With many companies' sales and profits under unexpected pressure, rising benefit costs are a more urgent concern than ever. Reviewing claim payments is also an excellent way to assure employee-plan members and their families receive the correct covered services as promised by their plans.