Use Patient Liaisons to Reduce Patient Expense, Increase Revenue Cycle Productivity
Whitepaper | Donald Drummy
Senior Director of Third-Party Coverage, Change Healthcare
Donald leads the team supporting the Change Healthcare Third-Party Coverage solution. Previously, he served as vice president of medical reimbursement and director of eligibility services for Medical Reimbursements of America, LLC.
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.
An academic level 1 trauma center with 500+ staffed and licensed beds increased its MVA collections by partnering with a vendor for third-party coverage advocacy. The center reduced its average billing cycle time for these claims by more than 21 days, and realized $7 million in annual savings.