For years, medical and prescription costs have risen continually. Then there was the coronavirus pandemic that caused unprecedented spikes in utilization. General inflation is adding to the usual upward trend of medical expenses. Therefore, health plan auditing services have rarely been needed more than they are this year. Reviewing claim payments with a fine-toothed comb is an excellent way to understand what is happing with expenditures and to catch recoverable overpayments and errors. Large employer plans have millions on the line, and finding meaningful savings helps the bottom line.

 It's a simple fact that oversight is always valuable. There's also the experience that claims audits recover four times as much as they cost in many cases. They are budget-friendly, and the return on investment is considerable. Since COVID, more plans than ever are having their auditors monitor claims payments continuously. The ongoing service runs on the same systems and software as the original audit and is just as accurate. Imagine receiving a monthly report in an easy-to-read format with all the details about irregularities in claim payments. When you have real-time information of such quality, it is extra helpful.

 Specialist claim auditors have long track records of recommending systemic improvements in claims administration. They are system tweaks that make significant improvements and savings over time. The results will impress anyone in-house at a self-funded plan and responsible for budgets. It doesn't add cost to the service and provides natural oversight to third-party administrators and pharmacy benefit managers. As audit firms work with clients over the long haul, they can add value in many ways. Nothing substitutes for the experience of auditing claims over several years.

 It's worth noting that today's 100-percent audits are vastly different from random sampling. They're the result of improved technology and electronic reviews that are fast and highly efficient. It's why claim auditing has become more of a management consulting function than one solely focused on regulatory compliance. C-suite management facing quarterly earnings reports to the investment community need factual information about items affecting the balance sheet, and medical claim costs are among them. It helps everyone to have solid data confirming the accuracy of claim payments and expenses.