Right now, your inbox is probably filled with dozens of pitches from vendors who promise that outsourcing will lead to increased revenue, lower costs, and improved efficiency.
That’s all true—but it’s a significant oversimplification in the context of complex claims, particularly motor vehicle accidents. While MVAs result in well over $450 billion in healthcare costs annually, getting reimbursed for providing that care is among the most challenging tasks in healthcare revenue cycle management. Few hospitals realize that MVA claims require an entirely different billing and revenue recovery process.
Sure, the short answer is, you’ll most certainly increase reimbursement by outsourcing MVA claims—by as much as 70%, based on our experience. However, what you really need to know are the three reasons why:
1. You’re not set up to manage multiple payers.
Hospital PFS teams are accustomed to managing various types of health insurance—Medicare, commercial health insurance, etc. But motor vehicle accidents are third-party liability claims, which means they are likely to be covered by auto policies or other liability insurance. In MVA cases, as many as four or five different insurance carriers could potentially be responsible for paying one patient’s medical bills. A whole different set of rules apply when some of them are liability carriers.
For example, auto insurance, such as first-party medical payments coverage (Medpay) and personal injury protection coverage (PIP), is typically carried in finite amounts, which auto insurers often pay out on a first-come first-served basis. If hospitals wait their customary 30 days to bill, they may find they’re last in line to request reimbursement from a limited pool of funds.
Further, each payer has its own filing deadline schedule, and there will be decisions to be made based on the merits and progress of any auto claim. Determination of liability may be pending the outcome of an investigation, which in turn will determine the most appropriate payer.
As experts in MVA claims, Argos Health monitors the entire payer landscape and coordinates benefits for every claim. We rigorously track deadline schedules and payer rules to determine which policies should be billed primary, secondary, tertiary, and so on. Skillful management of multiple payers is critical to securing appropriate reimbursement on MVA claims.
2. You’re missing most of your MVA cases.
Hospitals typically rely on their registration teams to identify patients being treated for MVA-related injuries, as well as to collect the necessary insurance information to bill liability carriers. That strategy is flawed, however, as it relies almost exclusively on conversations with injured patients. The practical reality is that only a fraction of patients in an ER setting can reliably communicate their MVA status, much less provide third-party insurance information.
The most effective way to identify MVA accounts is an automated assignment process that leverages the patient’s health record. Argos Health’s automated claim assignment logic is used to build a simple workflow in a hospital’s EHR that identifies MVA cases based on billing codes. Claims flagged as MVA are sent immediately to our intake team to begin working the claim.
Once the account is in our inventory, our insurance specialists search for all payers that may be responsible for reimbursing the hospital. While hospital PFS representatives typically bill only payers identified at registration, we consult numerous sources—including accident reports and national liability claims databases—to uncover every possible payer.
3. You need attorneys on the MVA team.
Many states allow healthcare providers to assert statutory liens for care provided in cases where a third party is potentially responsible for the injuries sustained. Where available, hospital liens are a critical component of the revenue recovery process for MVA and other third-party liability claims.
A hospital lien grants a hospital a secured interest in a potential settlement awarded to an injured party. Although they are commonly confused with liens attaching to personal property, such as a garnishment or judgment lien, hospital liens are entirely different and attach only to funds paid to claimants as part of their personal injury settlements. A secured interest in a personal injury settlement guarantees that the hospital will be paid first before funds are disbursed to the claimant.
The process of completing all the necessary steps to file a hospital lien is known as hospital lien perfection, and it’s an arduous process. By necessity, an MVA team must include attorneys who are constantly monitoring the case law surrounding hospital liens. Lien statutes in every state are always mired in controversy as plaintiff’s attorneys often argue over how to interpret the statute, when to apply it, and how much a hospital can collect. When actively involved in the process, attorneys help ensure that a hospital’s rights to reimbursement from any auto claim are protected.
Argos Health is a KLAS top performer and the Black Book top-rated complex claims vendor for three years in a row. We handle motor vehicle claims from start to finish, with the resources and legal expertise to manage the hospital lien process and advocate fiercely for proper payment. Learn more here.