What Makes 100-Percent Claims Audits More Effective?

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TFG Partners is a healthcare claims audit and monitoring firm that has been leading the industry for nearly 30 years. We’re fully independent and work with Fortune 500 and mid-sized companies to improve benefits plan performance. Our service is unique because it includes audit, analysis,

When it comes to benefit plan auditing, the 100-percent method is the most effective. It's because it reviews even claim for an unmatched level of accuracy. While random-sample auditors may make promises about their work accuracy, they can't compete with a 100-percent approach. Only when every claim is reviewed individually can there be guarantees about maximizing the efficiency of an audit and catching every mistake. When a two-step process is in place with an electronic claims review and manual follow up, there is an assurance that the audit is up to the highest standard.

The 100-percent approach was pioneered during the 1990s as technological advances made it possible. The cutting-edge firms revolutionized the industry with their improved approach. They were the first to harness the power of better computers for a closer and more detailed look at claims processing and administration. The more exceptional abilities have been a boon to mid and large size companies with self-funded medical plans. Many millions of dollars paid in error have been recovered, and employee-recipients better served in the long run. It's also been a useful defense against rising medical costs.

Efficiency and accuracy gains in medical benefits plan claim administration are a natural result of 100-percent auditing. It helps administrators eliminate entire categories of errors and conserve plan dollars while serving recipients well. While a random-sample method may uncover some irregularities, it cannot compete with a sample that includes 100-percent of the claims processed. Financial and human resources professionals tasked with plan management can rest assured that a complete audit implemented by a full-service benefits plan auditor will yield superior results every time.

The two-step review that includes a manual analysis of the results produced by an electronic audit is another factor in making the 100-percent method more effective. To the surprise of many benefits plan managers, it requires less time on the client company's part than other methods. More accurate claims audits are budget-neutral at a minimum and, in most cases, lead to long-term savings that far exceed the audit cost. They're an excellent option for self-funded plans and help meet regulatory requirements. Finance departments find it easy to support them because of the cost savings they produce.