Health Plan Economics Newsletter : Issue 3

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Issue 3 : Third Quarter 2009


	Random sample audit methodology misses 90 percent or more of claim errors, study finds.

	PreAudit, the quick way to know if you have big problems with health plan expense.

	“We have the tools to help employers control current and future health plan expense starting now.”

HDM

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Random sample audit methodology misses 90 percent or more of claim errors, study finds

In our June 2009 newsletter, we reported that Healthcare Data Management, Inc. (HDM) had commissioned an independent study of the relative efficacy of the 100-percent-of-health-plan-claims audit versus the audit methodology that relies on a random sample of between 200 and 400 claims to identify claim errors…wasted expense.

The findings are in, and they are resoundingly conclusive: multiple disparate data sets were analyzed and the results compared. The analysis revealed that random sample audits would have missed a minimum of 90 percent or more of the errors identified by HDM’s 100-percent-of-claims audit… read more>

HDM announces PreAudit, the quick way to know if you have big problems with health plan expense

Beginning October 20, 2009 and continuing through December 31, 2009, Healthcare Data Management, Inc. (HDM) will offer PreAudit, a scan of two months worth of recently paid medical claims or prescription drug claims.

The offer is targeted at self-funded plans that will find it useful for one of two reasons: 1) to decide to pursue a comprehensive look at their health plan expense, because of some suspicion of error or plan misuse or 2) to provide an inexpensive double-check of a recently completed retrospective audit that was based on a random sample of paid claims… read more>

“We have the tools to help employers control current and future health plan expense starting now.”

These are the words of J. Michael McNamara, CEO of Impact Health, an acknowledged leader in on-site health promotion and biometric screening.

McNamara was explaining the value of combining biometric testing with leading edge predictive modeling and HDM’s concurrent health plan analytics service, BenefitsWatch.

According to McNamara, Impact Health is encouraging its health screening clients to take advantage of its partnership with Biosignia, a North Carolina-based predictive modeling company and its revolutionary population disease risk assessment tool, Know Your Number©. “This evidence-based morbidity modeling method is best described as the ‘Next Generation Health Risk Assessment’ (HRA)… read more>