At MCM CPAs & Advisors, we think beyond your bottom line. We provide our clients with services that reach far beyond the traditional tax and assurance offerings of other firms. We do this by leveraging high-impact expertise in an array of industries, technologies and operations. We identify opportunities, and anticipate challenges, from all angles, for all of our clients.
For many clients, self-funding its insurance plan has been a successful way to mitigate the impact of rising healthcare costs. Self-funding brings on additional fiducial responsibilities. It is imperative to your bottom line to understand the direct correlation between unnecessary and inaccurate claims. If a third party administrator (TPA) inaccurately processes just 2% of claims, it equates to a $200,000 overpayment for a plan with $10 million in annual claims. MCM’s processing audits have historically identified a 2%-5% error rate.
MCM is one of the only Top 100 accounting firms with the expertise to perform claims accuracy and performance audits. Our national practice has successfully performed more than 300 medical, life, disability, dental, vision, FSA, pharmacy and workers’ compensation claim audits. Our accounting professionals also bring their unique background to the process, evaluating not only the present issues, but also the claims payment and process controls.
WHEN IS A CLAIMS AUDIT RIGHT FOR ME?
MCM highly recommends all self-funded plans with more than 250 covered lives consider a claims audit if any of the following is needed or present:
CLAIMS AUDIT PROCESSES
MCM provides an objective, independent claims audit focused on your needs. Our methodology consists of evaluating the design of controls, testing the major claims processing cycles, determining the accuracy of payments and identifying any value savings recommendations. Our risk-based approach is designed with management to customize a specific plan for your organization. Our experience encourages the following testing procedures and assessments:
To see if our services are a good fit for you, complete a self-assessment here or contact Sean Ennis, CPA, MBA 502.882.4448.