This is a 2019 SHRM Annual Conference and Exposition (#SHRM19) interview is with Healthcare Horizons, a healthcare auditing firm. Below is a quick Q&A with the company.
Who is Healthcare Horizons!? Tell us everything, just as you would someone approaching your booth and asking you this question at #SHRM19 in Las Vegas.
Healthcare Horizons Consulting Group, Inc (Healthcare Horizons) is the industry leader in performing comprehensive healthcare claims audits for self-insured employers and government entities. We provide a major cost-containment strategy by reviewing every paid claim and returning millions of dollars annually to self-insured employers’ health plans through our 100 percent difference. We audit every claim to test the performance of the plan’s administrator with the goal of recovering overpaid healthcare claims, while at the same time identifying and correcting root cause issues.
Let us in on the magic. What’s the audit process like at Healthcare Horizons? How do you utilize your own tech and processes to ensure accuracy?
Healthcare Horizons differentiates our services via our industry experience and hands-on approach. While we utilize data analytics and the latest industry resources, our personal commitment to each audit and client sets us apart. We do not perform “check the box” audits. We have real people using database tools, with a keen experienced eye and industry expertise. Our process does not just audit a “random sample” of claims, which istypical in the industry. Our process is a true comprehensive audit, finding systemic issues, correcting those errors moving forward. We make recommendations based on our findings which can lead to future savings. The best news is that comprehensive audits cost no more in time or money then performing ineffective random sample audits.
What are the biggest challenges companies face when auditing? How do they overcome those challenges?
Many of our clients are under the impression that an audit will take up too much of their time and resources. While we welcome client involvement, the process requires very little time investment. We will ask for plan documents and an introduction to the carrier, and we take it from there all the way to the audit report of findings. In addition, benefit managers will often defer this cost-containment duty to their broker or TPA, failing to realize that these sources generally only recommend a random sample audit that reviews randomly selected claims, missing an opportunity to find large one-off errors or systemic issues.
What do you wish more HR professionals and recruiters knew about healthcare auditing?
HR professionals should know that some volume of error does exist in their medical claims expense. These errors can be significant. Healthcare Horizons commonly identifies six-figure overpayments on single claim transactions. Auditing is one strategy to contain rising healthcare costs by returning dollars to the bottom line. Auditing also helps our clients meet their fiduciary responsibility to their stakeholders. It is important to note that when it is time to renegotiate the TPA service agreements, companies should demand audit rights that allow for a full audit of all paid claims and not just random sample auditing.
For anyone who won’t be able to make it to the Healthcare Horizons booth in Las Vegas, what do you want them to know?
All self-insured employers should be performing some type of external audit on medical claims processing to ensure the accuracy of plan design as well as recouping dollars that belong to the plan in overpaid or erroneously-paid claims. While it is fine to trust your carrier, you should also take steps to verify. DO SOMETHING! Asking your TPA or broker to audit the claims payments of your health plan is like asking your realtor to perform the home inspection on a new home purchase.
Visit the Healthcare Horizons booth #3317 at #SHRM19!
Brett Farmiloe is the Founder and CEO – and currently CHRO - of Terkel.io, a platform where business leaders can answer questions related to their expertise and get published in articles featuring their
insights. Brett is a #SHRM22Influencers and has also been a keynote speaker at several state SHRM conferences around the topic of employee engagement.
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