Healthcare Cost Control
Healthcare costs account for 16% of the nation's economy. For most companies, the necessity to outsource most of the claim adjudication processes makes it the least-monitored corporate expense. Claims are often overpaid due to fee structure misapplication, duplicates, unimplemented benefits, CPT coding errors, claim-payer errors, medical errors, misrepresentation of health conditions, unenforceable and unnon-auditable contractual provisions, and finally, an overall lack of internal controls.
Due to today's complex healthcare issues and ever-increasing medical costs, relying solely on traditional in-house or third-party review is simply not cost-efficient.
The CRS solution encompasses a suite of comprehensive examinations, including analytical, prospective, and retrospective audits. Utilizing unique proprietary electronic edits, database analyses, and focused audit procedures delivered by healthcare industry claims experts, CRS stands as the leading one-source provider of claims cost-containment and recovery services. With
documented audit results of up to 8% identified overpayments, our unique approach provides direct impact on financial and service quality improvement.
Initially, clients may elect to adopt a specific service based on immediate needs and then evolve to utilize the full scope of the program over time, for maximum and sustained benefits. Cash savings and future healthcare savings are generated through 5 major program components:
Benefits of CRS' Healthcare Cost Control include:
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Prevention of Ineligible Dependent Coverage and Fraud
CRS gives its customers the opportunity to clean up their healthcare plan and reduce healthcare costs without a reduction in benefits or having to make cuts in beneficial areas of the budget. An easy opportunity to reduce spending is to perform a Dependent Eligibility Verification and rid your plan of ineligibly covered dependents; on average 4-15% of an employer's dependent population is ineligible and should be dropped from coverage. Some employers require only a signed list of dependents when enrolling their employees onto their healthcare plan, and at most (possibly outdated) documentation of a marriage for spousal coverage. This leaves their business at high risk of insurance fraud and erroneous, wasteful claims being paid.
Dependent and Subscriber Verification is especially necessary in today's economy – healthcare costs are expected to rise more than ever in the wake of the Healthcare Reform, and healthcare fraud is steadily rising in this uncertain and job hungry economy. CRS does a full dependent and subscriber verification using a proprietary electronic program that is 100% paperless, web-based, and provides real-time updates to promote simplicity, peace of mind, and customer satisfaction. Our goal, while providing the most thorough and accurate verification on the market, is to make it a friendly process for both our customers and their employees.
Our verification process is one that offers an average ROI of over 400%.
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Identification and Recovery
Retrospective claims audits scrutinize all aspects of the claims process for error identification and correction. Typically, retrospective audits analyze 2 years of paid claims history and recover on average 2 - 5% of total claims paid. Errors found in retrospective audits often identify system wide issues that require correction to control future errors. This can lead to future cost reduction as well as cost recovery on overpaid claims.
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Contract Analysis, Operational Reviews, and Recommendations
An independent and objective assessment can be initiated from several different starting points. For example, a review of the claims-processing practices and procedures is conducted during the claims-recovery process to evaluate administrative and claims-policy compliance, assess performance standards, and identify processing issues. Our analysis can assist benefits administrators in measuring program performance and monitoring ongoing effectiveness of cost-containment initiatives and benefits changes. From the employer's perspective, a review may involve controls in the management of vendors that impact the delivery of third-party services. Finally, from the employee perspective, we also have tools to help the frontline in making decisions that ultimately will impact the initiation of claims.
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"Front Line" Solutions to Healthcare Cost-Control
CRS provides Employee Wellness Services to address your healthcare costs on the "front line." Our employee wellness educational seminars and workshops teach your employees how to become conscientious consumers of healthcare. We empower your employees to make optimal healthcare decisions that will reduce your healthcare costs. Many employers choose to support wellness initiatives with financial incentives for employees (such as gift cards and premium reductions).
Our patient tools and healthcare navigation map enables your employees to feel in control of their health to manage their healthcare costs effectively. Our Patient Advocates provide a trusted resource for people who need help and support navigating the healthcare system efficiently.
"Front Line" Solutions are provided on a flat fee schedule at a "per employee" rate and are custom designed to fit your specific employee population.
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Ongoing Prospective Savings
We provide our clients ongoing surveillance of claims activities and a proprietary service that requires verification of a visit or charge before claims are submitted. We also provide pre-implementation audits if a new vendor is selected for claims processing. Finally, we provide periodic audits for testing internal controls as well as onsite training of internal audit staff. In some cases, we co-source with internal audit staff on the more intensive audit tests.
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CRS prides itself on being as noninvasive as possible, and we generally require only minimal resources to begin. Trained medical experts examine and review 100% of your past transactions. All services in connection with the audit are provided by CRS team members, including our subject matter experts and our recovery staff. We strive to ensure quality and minimize disagreements. Our flat fee schedules and performance-based compensation is driven on results and calculated on a share of the savings that our services generate.
We are committed to being your partner in ensuring the financial integrity of your medical claims!
Discover CRS' profit improvement and risk management solutions for your company.
Contact Us for a complimentary consultation.