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.
MVA claims are extremely painful to manage and require substantial time and streamlined effort in order to obtain optimal and accurate reimbursement. An extensive patient engagement strategy to make sure that all necessary information is collected up front must be in place to ensure that every available payer is identified. Then comes the tedious verification process that must follow each insurance lead to ensure that the claims be sent to the correct payers, which is often not the patient’s health insurance. Accident claim billing remains almost completely manual with no scheduling and no electronic transactions. Additionally, there is a hazardous compliance risk involved and a myriad of state and federal regulations that hospitals must follow when determining coordination of benefits, mandating a knowledgeable legal team who is well-versed with lien laws and COB.
Due to the expansive effort and dedicated focus that accident claims require, providers are often left in the dark about how much revenue they can actually collect within this niche. This is due to a lack of visibility that providers have regarding the specificity of managing and tracking these claims. Because many aren’t aware of the higher reimbursement rates available for these claims from other payers (i.e. Property and Casualty and Liability carriers), they are under-managed and often sent to collections. However within this niche of claims lies tremendous opportunity for additional revenue, and it starts with recognizing the importance of separating Motor Vehicle Accident claims into their own financial class.
Separating MVA claims into a separate financial class helps hospitals identify and collect additional revenue from an over-looked source, strengthening the bottom line while simultaneously improving patient satisfaction.
Click below to learn about the Key Performance Indictors that are imperative for effective accident claims management.