What You Don't Know WILL Cost You!
You've hired a professional administrator to pay your organization's
medical and dental claims, and you're probably pretty happy with their
service. Or, maybe you self-administer your plan, and your staff pays the
claims in-house. In either case, you feel things are under control. But are
Did you know that, on average, professional administrators and in-house
claims paying functions overpay nearly 1% of the dollars paid on the
checks they issue? That's right! Our experience with hundreds of clients
over the last three decades consistently shows that nearly 1% of payments
issued were overpaid. And that's because administrators and claims staffs
are hired to pay claims, and issue payments quickly, so your employees are
happy. But, fast is not necessarily right.
Although 1% might not sound like much, it represents over $32 Million
overpaid during a three year period for the nearly 90 clients we reviewed during
that time. In fact, we found the average plan overpays more than
$375,000 per year.
You might ask, "How could they overpay that much?" Well, we've seen
hundreds of reasons why claims were overpaid.
Some of the most common mistakes are:
- Issuing duplicate payments or paying duplicate charges, due to making
errors, such as entering incorrect coding, keying incorrect service
dates or other data, paying charges under the incorrect patient's
account (such as, member instead of spouse), and paying the
- Not taking PPO discounts, applying incorrect PPO discounts or allowances,
paying incorrect PPO per diems, or entering incorrect repriced amounts
- Paying charges for non-covered services
- Paying charges that should have been denied due to workers' compensation
- Incorrectly paying non-PPO benefits because the PPO tapes had not been
loaded timely by the data processing area
- Applying two times the outlier benefit in error
- Not taking the pre-certification penalty
- Not coordinating benefits or incorrectly coordinating benefits with the
- Incorrectly taking a percentage discount instead of paying the per diem rate
- Incorrectly overriding eligibility
- Not applying per diem stop loss benefits
- Entering an incorrect counter
- Releasing payment for surgery charges before case management
negotiated a discount
- Using incorrect per diem rates
- Paying for unbundled surgery or maternity charges
- Setting benefits up incorrectly on the system, for items such as
coinsurance percentages, benefit maximums, deductibles, and mental
nervous, substance abuse, and chiropractic limits
So, ask yourself: How many dollars does my plan pay? What is 1% of
that amount? Now, is it worth hiring Benefit Plan Audit Services (BPA)
to find those overpayments?
We know you want to minimize your health care costs. And you don't want
to waste money on unnecessary claims overpayments. We will help you
find those payment errors, so you can recover the overpayments, and
make sure they don't happen again. And, if you prefer, we can help you
collect payment errors we identify. We understand what you want, and at BPA, "What You Want, We Want."
We can help you save money by reducing your health benefits claims expense.
Please click here to email us for more info: firstname.lastname@example.org.
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Benefit Plan Audit Services, LLC
961 Amherst Avenue
Los Angeles, CA 90049 USA
Phone: (310) 629-5372|
FAX: (310) 442-2859