Choosing to pursue a health plan audit is a big decision that should not be taken lightly. There are many questions that should be answered, and options to examine before considering whether or not to move forward. For example, what is the potential impact on the budget, on my time, on the employees, etc.
The following are some considerations that ought to be part of your decision matrix.
• Every organization is responsible for ensuring that their pre-tax health plan is only paying for eligible claim expenses for eligible plan participants. Can you answer this with 100% confidence?
• Enrolling ineligible dependents or mistakenly leaving ineligible dependents on the plan drives up the cost of benefits for everyone. Every audit we have ever conducted has uncovered ineligible dependents and unnecessary claims costs.
• Family demographics are increasingly complicated, and constantly changing – divorces, step-families, guardianships, custodianships, etc.
• Previous audits, and random audits, are unreliable because dependents’ eligibility for coverage changes over time.
• Full enrollment file reconciliation and feedback from employees help to ensure accuracy of enrollment records.
• The measurable savings from the project will exceed all project costs – positive return-on-investment guaranteed.
We invite you to have a conversation with Mike Tehan, the President of MedBill Management. Feel free to include your broker/consultant. Spending a few minutes talking about the different audit options, and the pros and cons of the various approaches, should go a long way toward making the decision easier.
Dependent Eligibility Verification
Learn more about this critical component of managing compliance and controlling costs for all of your health plans.