Managed correctly, auto-related accident claims yield higher reimbursement rates than most other financial classes. When under-managed, accident claims can expose a hospital to costly compliance risks, lost potential revenue and patient dissatisfaction. Below is a list of KPI’s that should be used to track and manage auto accident claim performance:
Patient satisfaction has become an increasingly important focus for hospital CEOs nationwide. Not only does the voice of the patient impact a hospital’s actual reimbursement rates, it continues to amplify with the increasing dollars held in the “patient responsibility” bucket. Expectations from patients are extremely high, and innovations around price, service, and access have become imperative for providers.
Accident claims management is complex. Patient accounts resulting from motor vehicle accidents and/or workers’ compensation injuries are largely paper-based and difficult to resolve. The skill set required to properly manage these claims is broad. A legal understanding of the state and federal laws is certainly a must, as is expertly trained registration and billing teams. The following 5 paragraphs explain areas required for the proper management of accident claims and help explain why many successful health systems have chosen to outsource these claims.
Class Action Lawsuits for inappropriate billing of Liability Insurance represent a growing threat to hospitals across the nation. For nearly 15 years, Medical Reimbursements of America (MRA) has helped hospitals avoid the hidden dangers of incorrectly billing Liability insurance for accident claims. MRA’s legal team has tracked several suits that have arisen due to incorrect interpretations of contracts related to Liability insurance billing for accident claims. In each of these lawsuits, the provider has incorrectly pursued Liability insurance primary to the patient’s Commercial Health insurance. A summary of these lawsuits is presented below in order to help hospital billing offices avoid compliance-related Class Action Lawsuits in the future.
Minimize your Hospital’s Exposure to Financial Clawback
Recently the IRS released final regulations for 501(r) that have led to a number of questions around financial assistance and collections policies for 501(c)(3) providers. The impact of 501(r) on accident claims tends to be overlooked because accident claims typically account for less than 3% of outstanding accounts receivables. However, when managed properly, accident claim reimbursements can significantly improve financial performance. It is imperative that providers properly adhere to the new requirements defined in Section 501(r) in order to compliantly maximize revenues on accident claims and prevent potential clawbacks from FAP-eligible patients.
Healthcare executives are faced with a variety of hurdles when managing motor vehicle and workers’ compensation related patient accounts. Here are six major challenges to be aware of in this realm of accident claims management, as well as some recommendations for overcoming them:
Reimbursement pressures felt by providers today are at an all-time high and are forcing hospital executives to come up with creative approaches for new sources of revenue. Yet some providers remain unaware of additional dollars that are hidden within the Motor Vehicle Accident (MVA) financial class. Why? Most providers do not treat MVAs as a separate financial class, due in large part to the highly complex and mostly manual processes required to resolve these difficult claims. While this narrow niche of AR typically represents only 2% of gross charges, these claims have the potential for significantly higher net revenue when comprehensively managed.