How to decrease medical billing errors through advocacy and employee engagement

In the intricate landscape of employee benefits, medical billing errors quietly undermine the financial viability of employer-sponsored health plans.

For seasoned benefits professionals charting this complex terrain, helping employers implement proactive strategies is the first line of defense. 

Financial implications of medical billing errors and fraud

With a steady rise in the frequency of medical billing errors comes substantial and diverse financial impacts on both benefits consultants and employers. And in today’s tumultuous economic environment in which many are operating on razor-thin margins, a vigilant approach to claims management is not just advisable, it’s imperative to mitigate the impact of these errors on employers’ bottom line. Some of the most significant financial consequences of medical billing errors include:

• Higher health care costs: When employers offer health insurance to their employees, they may bear the brunt of these extra costs, either long-term through higher premiums (such as for employers participating in group health insurance plans) or short-term through direct payment of claims (for those using a self-insured model).
• Wasted administrative hours: From the time and resources required to investigate and rectify inaccuracies, to handling employee concerns related to health care billing discrepancies and plan quality, benefits advisors and employers shoulder the burden of excessive administrative costs associated with resolving billing errors.
• Dissatisfied employees: It’s no secret that dealing with medical billing errors is time consuming and frustrating. The need for employees to pour time into disputing health care mistakes may result in decreased productivity, reduced morale, and dissatisfaction with benefit offerings, impacting the overall efficiency and atmosphere within the workplace.

Beyond simple billing errors, benefits advisors must also prepare employers to manage an even more sinister issue: medical fraud. According to the FBI, this type of fraud costs billions of dollars annually and contributes to increases in health insurance premiums, unnecessary medical procedures and taxes.

With so much at stake, how can benefits advisors best collaborate with their employer groups to prevent medical billing errors and fraud in the first place?

Proactive strategies to protect employers and employees

The world of medical billing demands meticulous attention from anyone who touches the health care benefits space. Common issues like duplicate billing, human error and fraudulent activity are compounded by the intricacies of in-network versus out-of-network charges. Manual or informal monitoring processes generally can’t cut through the complexity. 

Success lies in proactively identifying and resolving these issues before they escalate, requiring brokers to equip employers with the knowledge to navigate the rocky health care system terrain effectively. These three strategies can better position employers to do their part in warding off the impact of medical billing errors and fraud:

1. Leverage tech and advocacy solutions: Benefits consultants can work with employers to incorporate digital claims monitoring services and employee advocacy programs that streamline and support the claims review process. In turn, this can help identify potential errors for employees, flagging issues more efficiently than manual reviews. Advisors can also collaborate with employers using such tools to develop long-term benefits strategies based on patterns and trends in historical claims data, which can help right-size benefit plan design.
2. Stay informed and collaborate often: Advisors should keep employers apprised of industry trends, changes in regulations and new technologies that could impact their health benefit plans. Staying informed allows for proactive adjustments to minimize risks. Additionally, advisors can work with employers to regularly review and optimize health care plan designs, from adjusting copayments and deductibles to incorporating additional plan features. These tactics can create cost-sharing incentives and discourage unnecessary medical procedures.
3. Invest in employee education and wellness programs: From teaching employees how to understand and audit medical bills and insurance documents, to implementing comprehensive education programs and workshops on fraud prevention, fostering a culture of vigilance among the workforce is essential. Collaborating with employers to implement employee wellness programs can help slow the onset of chronic conditions and reduce the overall need for medical services. After all, healthy employees may require fewer medical interventions, leading to lower healthcare costs and better overall workplace wellness.

This proactive and comprehensive approach enhances error detection, reduces financial risks and ensures high-quality, right-sized healthcare coverage. Additionally, it helps foster and grow an employer’s crucial partnership with its workers to maintain robust and organization-wide healthcare stewardship.

Innovation and collaboration drive the future of benefits

Effective health care cost management boils down to two key components: technology and good, old-fashioned communication. All told, a proactive stance, fortified by a granular understanding of the health care landscape, a discerning eye for common pitfalls and the integration of cutting-edge claims management solutions, positions benefit advisors as true custodians of employer financial health.

The journey toward cost-effective, efficient employee benefits demands vigilance and a steadfast commitment to strategic, data-driven decision-making. Add in automated advocacy and strong workforce collaboration, and you have a recipe for more significant healthcare cost savings and excellent benefits, which only stand to improve the health of businesses and employees alike. Scott Speranza is the CEO of HealthLock – a digital solution that monitors members’ health care claims and notifies them of red flags putting their medical identity and finances at risk. HealthLock is a disrupter in healthcare billing and fraud protection, forging partnerships with financial institutions, employer groups and benefits providers to offer health data privacy solutions.