Every year, 3.7 million patients are treated in the ER for injuries related to motor vehicle accidents. Each one of them may have up to five different insurance carriers who could potentially pay for their care.
Knowing how to manage those payers is the art and science behind MVA claim reimbursement.
Motor vehicle accidents are third-party liability claims, which means they are likely to be covered by auto policies or other liability insurance. With both liability and health insurances in the mix, claims management becomes a delicate balance of benefit coordination—requiring extensive payer knowledge and rigorous deadline management.
An effective coordination of benefits strategy will help reduce denials and maximize MVA claim reimbursement. These are the guiding principles:
Principle No. 1: The most appropriate payer is sometimes an elusive target.
While health insurance claims are somewhat predictable, the MVA claims process is complicated by the potential for multiple payers with different reimbursement schedules. MVA claims experts track filing deadlines and discuss reimbursement options based on the merits and progress of auto claims. This critical effort ensures claims are filed to the highest reimbursing carrier.
Principle No. 2: Health insurance payers and liability carriers operate differently.
Hospital PFS teams are adept at managing filing procedures for various types of health insurance, including Medicare and commercial insurance. Different rules apply, however, when liability carriers are involved.
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. Hospitals must bill quickly to avoid being last in line to request reimbursement from a limited pool of funds.
Argos Health rigorously tracks deadline schedules to ensure important dates are not missed. We also follow payer rules to determine, for example, which policies should be billed primary, secondary, tertiary, and so on. In partnership with the hospital, we balance these factors to arrive at the optimal reimbursement strategy.
Principle No. 3: Hospital intake teams rarely collect accurate liability insurance information.
Hospitals typically rely on their registration teams to collect insurance information to bill liability carriers. However, only a fraction of patients in an ER setting can reliably communicate their MVA status, much less provide third-party insurance information.
Our insurance specialists search for all payers that may be responsible for reimbursing the hospital. We consult numerous sources—including accident reports and national liability claims databases—to uncover every possible payer.
Principle No. 4: Effective coordination of benefits requires full complex claims expertise.
A motor vehicle accident sometimes turns out to be workers’ compensation claim. An investigation of payers may turn up VA coverage. Argos Health offers the broadest range of complex claims services in the industry and can seamlessly transition to other modes of revenue recovery.
Does your PFS team understand the four principles of benefit coordination? Argos Health is a KLAS top performer and the Black Book top-rated complex claims vendor for three years in a row. We have the resources and expertise to manage motor vehicle accident claims from start to finish. Learn more here.