If you run or own a business, you already know you should be carefully planning and reviewing your finances, and you’re more than well aware that budgeting is one of the most important necessities for a profitable bottom-line. We’ve seen businesses live and thrive on well-laid out, attainable budget plans. On the flip-side, we’ve witnessed others sputter, choke and, eventually, suffer a premature end because finances weren’t budgeted correctly.
We all know that businesses and budgets don’t come in one shape and size. Depending on the size of your organization, you may have accountants on payroll that create your budget or you may be responsible for it yourself. Your budget could consist of just ten lines or it could be so complex that it has over a thousand. Regardless, budgets all come down to one thing: balancing the books and making the most out of your bottom-line. That’s why we are proud to offer CTI audit services for a variety of budgets. From the largest of Fortune 100 companies to the smallest of self-funded plans, there is a medical healthcare claims audit for you – and when you add on CTI’s 2:1 guaranteed ROI, you’ll soon see why we could be your budget’s best friend.
ELECTRONIC REVIEW AUDIT
This audit option is the least expensive of our audit services and is appropriate for clients who want assurance their claims are being paid in accordance with their plan specifications. It consists of 100% electronic screening of all claims and a review of a subset of targeted samples. Along with the screening, this option – and every CTI audit – comes with a focused operational review that covers claims adjudication, customer service and eligibility maintenance procedures as well as overpayment recovery, network utilization, appeals processing and workflow controls.
BEST-IN-PRACTICE REVIEW AUDIT
The next step up from our Electronic Review is the Best-in-Practice Review which includes a statistically valid random sample with a 95% confidence level and 3% margin of error. It also includes the focused operational review that covers claims adjudication, customer service and eligibility maintenance procedures as well as overpayment recovery, network utilization, appeals processing and workflow controls. It is designed to determine whether claims are being paid in accordance with contractual guarantees and will provide clients with comparisons to industry standards. Best-In-Practice Review also includes validation of provider discounts, PPACA, CMS and NCCI compliance, global surgery fee period analysis, as well as identification of claims that may be eligible for reimbursement under the client’s stop-loss policy.
COMPREHENSIVE CLAIM AUDIT AND ANALYSIS
We believe our Comprehensive Audit and Analysis provides the biggest bang for your buck. It is a combination of both of the audits noted above and offers 100% electronic screening with targeted samples as well as a statistically valid random sample audit. A comprehensive operational review provides additional value by including all of the features of our focused operational review as well as a review of insurance coverage, bonding, disaster recovery and business continuity along with HIPAA compliance. The combined power of electronic review and random sample auditing has the highest return on your audit investment. Not only will the Comprehensive Audit and Analysis identify opportunities for overpayment recovery, but it will also validate performance guarantees and compare administrator performance against industry standards for development of quality improvement plans.
Each of the above options provides you with assurance of your plan administration’s accuracy and the potential for recovery of erroneous claims overpayments. Optional eligibility verification for all claims is offered with each of these plans.
For more information on all of the services CTI offers, please click here.
For an in-depth look at CTI's industry leading Comprehensive Healthcare Claim Audits, please click on the graphic below.