Healthcare Claims Compliance
Concerns over healthcare dollars have become part of the national conversation and Miller Kaplan Arase LLP helps clients manage the increasingly complex challenge of compliance with medical plan provisions. We work with self-funded plans, as well as with insurer-paid plans governed by collectively bargained agreements. Areas of service include claims related to coverage of:
- Medical Benefits
- Dental Benefits
- Pharmacy/Prescription Benefits
- Other Health-Related Benefits
The identification of possible underpayments or overpayments is a major consideration in healthcare claim examinations. We also examine the proper application of deductibles, co-pays and out-of-pocket expense caps, PPO rates, billing errors and overcharges.
A Full-Time Commitment to Medical Claims Examinations
Serving employer benefit plans is a major focus of the firm. Within the employer- compliance reporting sector, Miller Kaplan Arase LLP is known for its extensive employee benefit plan audit experience. We have helped numerous clients accurately and efficiently uphold their obligations to employees in a timely manner. We work cost-effectively and are members of AICPA’s Employee Benefit Plan Audit Quality Center.
In our examinations of self-funded plans, Miller Kaplan sends an audit team to claim payers, such as Blue Cross and Blue Shield, to assess that claims are processed accurately and within a reasonable time. Our scrutiny involves gathering the correct information to support the fiduciary obligations and regulatory compliance of plan sponsors. Miller Kaplan partners present audit reports and share information that frequently assist employers in monitoring healthcare costs and identifying strategic opportunities and areas for improved efficiency.
For clients who are trustees of funds with participants governed by collectively bargained agreements, Miller Kaplan helps oversee and manage their custodial responsibilities. As we conduct audits of healthcare claims audits, we determine if contributions are accurate and in compliance with union bylaws for workers whose benefits accrue on an hourly basis.