Health Care Audits: Do You Know?
- That, as a sponsor of a self-funded health care plan, you have a fiduciary responsibility to your plan participants. Many plan sponsors protect their health care benefits plan's assets by engaging MedReview to perform health care audits that will help them meet ERISA, Sarbanes-Oxley and other regulatory requirements.
- That TPAs expect third party audits. TPAs have departments specifically designated to administer external audits. Your TPA or ASO agreement normally addresses your audit rights. MedReview gives your TPA an opportunity to review all audit reports and to respond. These responses are included in your final audit report.
- Focused Sample Audits, Random Sample Audits, Operational Reviews, Electronic Audits and Pharmacy Audits require very little of your time.
- Your TPA's internal health care audit program may never include a claim from your plan.
- In addition to detailed, in depth audit reports, MedReview forwards a monthly electronic audit progress report to each client.
- Most TPAs allow a maximum of 250 claims to be audited on-site.
- With the exception of a Dependent Eligiblity Audit, employees are seldom impacted by the results of an audit. If MedReview discovers an issue that could negatively affect a plan member, you decide whether or not to pursue the recovery of the overpayment.
- As TPAs and PBMs upgrade and modify business systems and practices, the risks of reporting and processing accuracy issues increase. Your ability to predict expenses and manage costs is impacted by your TPA's and PBM's business practices.