Audit 100-Percent of Your Medical Claims and See a Difference

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TFG Partners is a healthcare claims audit and monitoring firm that has been leading the industry for nearly 30 years.

Since the advent of self-funded corporate medical plans, there have been regulatory requirements for periodic audits. In the beginning, facility claims auditing was conducted with a random sample approach. It was better than nothing and uncovered broad systemic errors with some level of accuracy. But it's not hard to imagine how many mistakes the random-sample method missed. Thanks to technological advances, today's audits customarily review 100-percent of claims and have far greater accuracy. They uncover all errors and give plan managers better data with which to supervise claim administrators.

The 100-percent claims audit was an innovation of the 1990s that has been in use – and continuously improved – ever since. It revolutionized this auditing sector and forever increased expectations about what could be detected and corrected for no more significant investment of a company's time or money. Better computers and software work faster and down to a finer level of detail. They can dig into each claim paid to check it's accuracy and compliance with plan rules. Small errors that previously would have been undetected now are flagged right away. The opportunities to make corrections are consistently larger.

There is a direct relationship between the accuracy of an audit and the efficiency of the benefit (medical) plan being reviewed. As 100-percent audits discover mistakes that can be corrected, plan performance improves every time. Anyone who might have been skeptical about the possibilities at first was long ago won over to the side of 100-percent audits. Random samples can never compete with the accuracy of electronically reviewing every claim. It also assured plan members of a more fair allocation of resources – if everyone's claims are paid for services promised by the plan documents.

Nearly all 100-percent auditors include a follow up manual review of the inaccuracies and mistakes discovered electronically. It means all of your claims are given the most thorough review possible, and the amount of time you spend will be less. Plan managers find today's audit approach much less demanding than the days and weeks required to review a random sample audit findings. It's a genuine advance in every way and helps usher in a new era of improved plan performance. Any self-funded corporate benefits plan can be given a 100-percent audit. Medical, dental, vision care can all be checked.

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