Strategies To Successfully Manage Accident Claims
Unfamiliar Claims Processes
In recent years, many healthcare providers have adopted automated claims processes to streamline billing. These technology-driven workflows require few manual touches.
In comparison to standard claims, motor vehicle accident (MVA) and workers' compensation claims are far more complex. They are less familiar to providers, and require manual effort. Although they comprise only a small percentage of an organization's total claims, MVA and workers' compensation claims equate to millions of dollars in annual revenue for many hospitals. They also have a higher reimbursement rate than even commercial insurance.
Given the higher potential for financial benefits, it is essential that providers efficiently process these claims. By collecting complete, accurate insurance information at the front end, providers can manage these claims more effectively to ensure timely, more complete reimbursement.
As the primary purpose of auto insurance and workers' compensation carriers is to protect property and businesses, their systems are not designed to support healthcare transactions. Compared to traditional claims, providers must adopt a different management approach for processes such as eligibility verification, billing, and status inquiries.
To verify a patient's eligibility or inquire about reimbursement status, staff must call the insurance carrier directly for each claim. Billing is typically manual, with individual claims submitted via fax or mail rather than electronically. Collecting these claims is often costly due to the manual work involved.
As eligibility rules and requirements vary by state, hospitals must be able to identify which carriers to bill for primary or secondary coverage. For example, Virginia requires a patient's commercial insurance to be billed as the primary insurance; in most states, the auto carrier is primary.
Gathering Data at the Point-of-Service
Obtaining insurance information at the front end is essential for all MVA and workers' compensation claims. If hospitals wait until the patient is out the door, the information may never be recovered.
At times, patients may be reluctant to provide their insurance information, especially when they believe the accident was not their fault. Many patients do not fully understand how their coverage works, and they may fear insurance rate hikes. In these cases, hospitals must work diligently to uncover complete, accurate insurance information at the point-ofservice to determine eligibility.
Some organizations have found that using patient liaisons can help reduce patient refusals, minimize confusion, and provide support during a difficult entry process. The patient liaison begins the process by screening patients at the initial point-of-service, obtaining the patient's insurance information, accident information, and the carrier's insurance card when possible.
The liaison also collects any available data about the incident, including police reports or other pertinent information, and then contacts the carrier to verify coverage benefits and eligibility. Once qualification is determined, the liaison shares this information, answers questions, and walks the patient through the process.
Reducing Patient Expenses and Billing Cycle Time
Hospitals using patient liaisons can increase patients' awareness of their benefits, and help reduce or even eliminate out-of-pocket expenses. After an auto accident, patients who are transported to the emergency department (ED) often incur significant bills. ED visits often cost thousands of dollars, and patients are often responsible for a large percentage of this cost due to deductibles, copayments, and co-insurance requirements. Patients may be unaware that their auto insurance carrier will cover some or all of these expenses, which would otherwise be paid out-of-pocket.
Using patient liaisons also results in a more effective billing and reimbursement cycle, helping hospitals recover more money. Many hospitals choose to outsource this function to a vendor partner to benefit from expertise they don't have and choose not to develop due to the manual processes involved. By utilizing in-house patient liaisons or seeking a vendor partnership, organizations can decrease unnecessary expenses and minimize duplicate collection efforts.
Providers can also increase compliance with billing regulations by ensuring that primary and secondary carriers are billed appropriately. When both patients and providers alike are unfamiliar with these types of claims, there is a risk of inadvertently "double dipping" into health and MVA or workers' compensation insurance coverage.
Using patient liaisons to facilitate MVA and workers' compensation claims helps hospitals and healthcare providers improve the patient experience and ensure accurate, timely reimbursement.
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