Healthcare costs for employees represent a significant expense for corporate and nonprofit organizations. When budgeting, some employers may apply a fixed percentage increase and hope for the best. However, a more strategic approach involves medical claim and PBM auditing services to gain a clearer understanding of the costs. Many self-funded plans today rely on third-party processors for claim management, creating a gap between them and the data. Engaging auditors to review each claim and generate detailed reports on the plan’s financial activities can improve budget forecasting.
The more insights you gain, the better your predictions will be. Bringing in an audit firm to analyze health plan costs can reveal trends. Skilled auditors are adept at identifying early signs of cost increases, which can be beneficial for managing your budget effectively. Moreover, when errors in claims processing are identified and addressed, it can directly impact your financial planning, especially if those errors have been leading to substantial cost growth. Properly managed plans ensure that every claim is accurately processed, which translates into more stable annual costs under normal circumstances.
When working with third-party claim processors, they often tout low error rates alongside attractive negotiated rates and robust provider networks that should benefit your employees. However, these processors typically come with fees that are meant to offset your in-house claim handling costs. The real question is about achieving accuracy, and that’s where an audit plays a critical role. Such audits can offer verification of whether the promises made by TPAs hold true. If discrepancies are found, you can leverage the data from the audit to negotiate better terms, strengthening your position as a client.
Beyond just health plans, pharmacy benefit plans also deserve expert auditing attention. Ensuring that prescriptions are filled according to established formularies and that promised discounts are applied is crucial. With medication prices soaring, it’s vital to take pharmacy auditing as seriously as you would medical claim reviews. Together, these audits can lead to significant financial savings. Starting your budgeting process with a thorough audit allows you to examine the previous year, offering valuable insights as you prepare forecasts for the upcoming year. There’s no substitute for having concrete data.
