HR Best Practices

Containing Health costs through Data Mining

Insufficient Hours Worked

FACT:

Many plans have a minimum hours worked provision, such as 32 hours per week.

PERCEPTION:

Plans or administrators are administering time and attendance related eligibility data correctly.

REALITY:

Medical and pharmacy claims are being paid out erroneously due to insufficient hours worked. In fact, we recently audited T&A data on behalf of a self-insured client. One member received medical benefits exceeding $140,000 and shortly thereafter, left the employer.

OPPORTUNITY:

HR Best Practices is the only auditing firm in America that audits time and attendance data. In order to prevent this from happening in the future, clients can hire HR Best Practices to verify eligibility on a pre-pay basis or hire HR Best Practices to reconcile eligibility on a post-pay basis.

NEWSFLASH: Subrogation specialists “estimate that between 1% and 3% of health-care spending is potentially recoverable to the health plan.” Wall Street Journal, November 20, 2007 Read More (subscription required) - Learn More about Subrogation

Differentiators

Change Agents
Independence
Comprehensiveness
Technology

Audit Working Spouses

Removing working spouses or adding a spousal surcharge provision provides greater savings than a dependent audit.

Hot Topics

Customer Quote

Chief Internal Auditor

“HR Best Practices goes beyond the normal practice of manual sampling and testing of claims by using advanced software they have developed to do extensive data mining and analysis of your full population of claims. The HR Best Practices team is not only expert in the health care field; but the team also has a real passion for healthcare auditing and cost containment”.