Leverage technology to uncover hidden ROI in your claims audit process

Many operational errors go undiscovered in the healthcare payer industry.

For payers, one of the most costly hidden errors occurs during prepayment claims processing. The magnitude of this problem is significant, as this represents a $2 billion annual expense from costs related to overpayments, rework, provider disturbance, and recovery efforts.

Across the payer industry, the average prepayment error rate is 7-10% (depending on the claim type). This adds up to an average additional cost of $2.36 per claim for administrative rework, which is buried in operating costs and hidden from plain view.

What many organizations don’t realize is that a seemingly minor increase in their prepayment claims processing and payment accuracy rates can generate significant savings. For example:

If your total claims payments average $80M per year, an increase of 1.5% in prepayment accuracy can equate to $1.2M in annual savings.

If your current audit process is largely manual or limited in scope, the savings your audit department can help generate will also be limited. Your auditors need more sophisticated technology and a more robust audit process to maximize the savings they can generate.

By leveraging technology, your organization can streamline your audit processes and reporting, enhance the effectiveness of your auditors, and generate significant hard and soft dollar savings and ROI:

Claims Audit Hard Savings

Claims Audit Soft Savings

  • Reduction in rework
  • Improved provider relations
  • Greater savings avoiding payment errors prepay than recovering overpayments post pay
  • Improvements in processing and payment accuracy result in lower processing costs per claim

These hard and soft savings can add up to hundreds of thousands if not millions of dollars a year for a payer, yet most organizations are not fully aware of the opportunity and invest little in their claims audit function.

The Solution

The Claims Audit Tool™ is an innovative application and proven turnkey solution that will greatly increase the effectiveness of your claims audit department and help generate significant ROI and savings for your organization. For more information, contact Laurie Kirkland at lkirkland@hcim.com or 888-454-0202, option 5.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.