Every organization across the United States is feeling the impact of the increased cost of healthcare. With the insurgence of Specialty brand drugs, government subsidies ending, and transition of the insurance market in association with the administration change at the highest office, most are resigned to thinking costs are going to continue to increase yearly for the foreseeable future. Although there isn’t too much we can do to offset the forces continuing to drive the costs higher, there are important steps that should be taken by every organization to ensure they incur no more costs or risks from the benefits they provide their employees now. Here are the top 3 unseen scenarios related to benefits that could end up costing your organization thousands of dollars a month 1. Premium leakage: There are certainly several scenarios that can cause premium leakage, the simplest example being someone leaving an organization but due to a breakdown in communication or enrollment process they are not removed from the carrier invoice. This error is compounded by the fact that most carriers have a 60 day back policy. This means if you discover you’ve been over paying for 6 months – you will only receive 2 months in credit back from the carrier. 2. Missing Coverage: A new employee joins a company but for some reason he or she (although elected the coverage) is missing from the carriers list. If the employee becomes ill or is involved in accident, the employer is completely exposed to not only the now uncovered health care costs, but also all the legal implications and potential fines of failing to provide coverage to an employee who elected coverage. 3. Missed changes to coverage: Employee’s lives are constantly evolving. Big life events such as a child being born, marriage, divorce and death, all can have impacts on benefits, and if not properly accounted for can expose an organization to losses and risk. If carriers do not register the changes, the employer may continue to pay for someone who is no longer a member of the plan. Worse is an omittance of coverage to members of an employee’s family. This can be a very costly mistake if the employee feels they were treated unfairly. The best way to address these risks and avoid the associated costs is to have a solid benefits reconciliation process in place. Although this can be achieved through a manual comparison of invoices to a list of covered employees, the resource involved is expensive, taking several hours each month of a benefits administrator’s time – not to mention arduous and fatiguing nature of the task and risk of human error. Leading organizations have found ways to implement automated processes into their workflows to ensure accuracy of the task and put their benefits administration team back to work on value producing tasks. If you are interested in creating an automation strategy to optimize your benefits reconciliation process, contact AdminaHealth and learn more about our Consolidated Billing and Premium Reconciliation solution.
The hidden costs of the second biggest operational expense in any organization
AdminaHealth® is an API-First cloud-based provider of the industry-recognized AdminaHealth Billing Suite® supporting healthcare, insurance, and voluntary benefits.
Our SaaS platform automates bill consolidation and reconciliation and streamlines payment management. We integrate with leading Enrollment and Benefit Administration systems to ensure accurate premium billing, resulting in significant operational efficiencies.
We support all billing types and coverages for small, medium, and enterprise businesses. We are the only billing SaaS solution that has adopted the NIST Cybersecurity Framework and has earned the elite HITRUST CSF Certification®.