In recent decades, technological advances have transformed the audit field meaningfully, and nowhere is it more apparent than in medical claim auditing services. Faster and more accurate electronic systems can quickly review thousands of claims down to a level of detail previously unimaginable. Auditing costs come down, and its value increases as more irregularities are flagged on the first pass. When overpayments are recovered and future errors prevented, the value of a thorough medical claim audit is undisputed. It's been a boon to self-funded employer health plans.

Not all audits and auditors are the same, and that's vital to keep in mind when considering which firm to use. Reviewing medical and pharmacy claims is a specialized business requiring dual expertise – the numbers side of auditing and medical billing (and coding). The best firms upgrade and refine their proprietary systems each year to catch more mistakes. Nothing replaces experience, and their daily work in the field assures they are ahead of the curve. The healthcare system changes and evolves annually, and prices go up relentlessly. Given those realities, claim auditing requires constant learning.

Auditing has taken a new place as a plan management technique as it provides oversight of outside claim administrators. It is helpful to review claims payments and their system set up with software from an independent auditor. If you're a plan sponsor, you no longer rely on your claim administrator to self-audit and report. Even when error rates are in the low single digits, the sums of money are large enough to be worth recovery. There is little downside; it helps your bottom line when your plan's payments become more accurate. Preventing errors in the future is an added benefit.

Thanks to the sophistication of their systems and software, claim auditors today can provide insight into your questions. You can investigate claim payment accuracy or examine other trends driving your costs and utilization. When the date is sliced and diced differently, you can see different trends that may be helpful. Audit setup has much to do with accuracy, and the best firms will ask questions, study your plan's provisions, and do a complete setup. When you first receive the results of a high-quality claim audit, it's eye-opening. From then on, you'll realize how you can maximize the value.