EBP1947. Health & Welfare Plans - Understanding the Claims Process and Testing Claims

Track: 
Accounting & Auditing
Field of Study: 
Auditing
Accounting
CPE Credit: 
1.5
Knowledge Level: 
Advanced
Advanced Preparation: 
None
Prerequisite: 
Extensive qualified retirement/ERISA plans/employee benefit plan knowledge or experience.

Tuesday, May 7, 2019
 
1:30PM-2:45PM

This session will describe how medical claims are processed by self-insured plans. We will explain the auditor's responsibility with auditing self-insured claims in a financial statement audit; and clarify the difference between a medical claims review and a financial statement audit. The session will also discuss best practices for testing these types of claims, including possible uses of data analytics; specifically on auditing claims and risk assessment.
Learning Objectives:

  • Reconstruct the life-cycle of a claim
  • Categorize the different purposes for each type of audit (i.e., medical claims audit, financial statement audit)
  • Assess risk assessment for a self-insured Health and Welfare Plan audit
  • Evaluate the auditor’s responsibility when auditing a self-insured health and welfare plan and describe the difference between a medical claims audit and a financial statement audit, and where the findings in a claims audit can help the financial statement auditor


SESSION SPEAKER(S)

CPA
Partner | Plante Moran
Senior Manager | Moss Adams LLP