Motor Vehicle Accident / Third Party Liability Complex Claims Revenue Recovery Service
Many providers find billing motor vehicle accident (MVA) and other third-party liability (TPL) claims to be difficult and time-consuming. Would you like to achieve any of the following?
- Easily identifying motor vehicle accident claims at time of registration
- Experienced attorneys negotiating on your behalf
- Submitting claims quickly enough to take advantage of PIP/Medpay benefits before they are exhausted
- Spending less time arguing with commercial insurance companies about denied motor vehicle claims
- Liens filed timely and in accordance with state laws
- Coordinating benefits properly, as defined by contractual requirements
- Higher levels of patient satisfaction
If so, Argos Health can definitely help.
Quite simply, we handle motor vehicle accident claims from start to finish.
Our straightforward automatic claim assignment logic identifies MVA claims in your hospital’s EHR system. This is critical since improperly submitting an accident claim to a government or commercial insurer can result in an immediate denial or a request for a takeback months later. As a result, by the time the claim is reprocessed as an MVA claim, there may be no funds available for payment.
To properly coordinate reimbursement on an accident claim, it’s critical to find as much information as possible about the accident and to do so promptly. Our claim intake team ensures motor vehicle accident claims are appropriately identified and immediately begin collecting the necessary information from insurers, government agencies, and patients.
Accident claims often involve multiple payers who may be responsible for payment of a hospital’s charges. The question is: from which payer should a hospital seek payment? Argos Health handles the complex decision points affecting a hospital’s ability to receive proper reimbursement on its accident claims.
In the case of an automobile accident, we’ll first attempt to collect payments via PIP/Medpay sources – medical insurance associated with auto insurance policies. If no PIP/Medpay is available or the available reimbursement doesn’t cover all of the hospital’s fees, our TPL experts take over the claim.
Our TPL team ensures liens are correctly filed according to complex state laws. We file liens against potential insurance settlements, not against patients or their property.
Hospital lien statutes are notoriously complex. Courts have routinely dismissed liens if a provider fails to strictly comply with the filing and notice requirements set forth in the lien statutes. Unfortunately, even if a provider perfects a lien, there are a variety of other issues that may arise under a hospital lien statute. For example, what happens when a provider treats a patient who was injured in a motor vehicle accident in another state? Is the lien valid against a cause of action in another state? This is a common scenario, especially for providers located near a state’s border, but most hospital lien statutes do not explicitly address this issue. Our attorneys follow case law across the country to ensure we are providing the proper guidance to our clients.
This phase of the process requires extensive communication and follow-up with attorneys, insurance claims adjusters, and other parties. Argos Health advocates on our clients’ behalf to ensure that proper payment is realized, always under the oversight of our team of employed attorneys.
While compromise is necessary at times to resolve complex accident claims, hospitals deserve fair and reasonable compensation for the life-saving treatment provided to patients. Therefore, litigation is sometimes required to enforce a hospital’s rights. When you work with Argos, this legal work is handled by the same attorneys already involved with the claim. This means they are familiar with the issues and history of these more complex cases. There are no extra fees associated with this legal work. Other firms charge their clients extra when litigation is required and often must use outside law firms because they have no in-house attorneys.
Sometimes what initially looks like a motor vehicle accident claim may turn into a workers’ compensation, Medicare, Medicaid, or commercial insurance claim. Argos Health has the expertise to accurately bill and collect from any payer that is responsible for paying a claim, and we do so until the work is done.
Watch the video below to learn more about the MVA revenue recovery process.
Argos Health knows that financial managers at hospitals and health systems are under pressure to keep their accounts receivable under control. MVA claims can take over a year to pay if litigation is involved.
This may exceed the point at which a hospital’s financial guidelines require that the claim be written off, have a bad debt reserve recorded, or be passed on to a general AR vendor.
Argos Health can work with your hospital’s financial team to develop a custom bad debt reserve policy for MVA claims that ensures your business office isn’t penalized for taking the time needed to pursue the reimbursement you deserve.
We’ll also agree up-front on how much flexibility Argos has in negotiating settlements with plaintiffs’ attorneys. This means you’ll only need to be involved in the unusual and more complicated situations, and the recovery process will run very efficiently.
Some payer contracts and state laws require that if commercial insurance is available, it should be billed first for an MVA claim. With today’s high deductible health plans, Argos can work these claims even after commercial insurance reimbursement and convert patient responsibility amounts from likely write-offs to revenue.
We recover revenue on MVA claims based on a contingency pricing model. Therefore, you don’t pay unless we’re successful. Allowing our experts to pursue your MVA claims means that any existing business office staff previously focused on MVA accounts can turn their attention to government and commercial accounts and collect more revenue in those areas.
But I Already Have a TPL Program…
Given the specialization required to pursue motor vehicle accident and other TPL claims properly, it’s not surprising that some hospitals believe they already have an effective program in place when they don’t. If any of these are true, you most likely do not have a robust MVA claim process in place:
- You pursue only PIP / Medpay reimbursement for MVA claims
- You or your vendor aren’t regularly filing liens against insurance settlements (this doesn’t apply in every state)
- You aren’t consistently using attorneys to negotiate settlements with auto insurance companies and plaintiffs’ attorneys. In some cases, this negotiation is left to the business office, leading to settlements based on misleading or incorrect information
The Argos Advantage
Argos Health sets itself apart from the competition by accurately and diligently working all claims from beginning to end, regardless of the ultimate source of payment or challenges along the way. Here’s one example:
A patient received a motor vehicle accident-related bill for an MRI from a collection agency and disputed the charges. Unfortunately, the collection agency representative was rude and told the patient not to call back.
After reviewing the related claim, it was discovered that the bill was from a radiologist and not the Argos Health client hospital facility. Our team member was able to pull the MRI report and determine the physician involved. Argos contacted the physician’s office and updated their billing office with the correct insurance information.
We advised the patient that all necessary corrective action had been taken to resolve the claim correctly.
This was a low dollar claim from a provider that was not even an Argos client, but our dedication to patient satisfaction meant that we went the extra mile for a patient of our client.
What Makes Argos Different?
Given the specialized knowledge and legal resources required to properly collect all the revenue a hospital deserves on motor vehicle accident claims, outsourcing is the answer. What makes Argos Health different compared to other vendors who provide MVA services?
Expertise and Experience
Our staff and attorneys have represented hospitals, health systems, and individual patients in these types of cases for many years. We maintain strong and professional relationships with our clients, attorneys, and insurers. Consequently, we’re able to efficiently and expeditiously resolve claims. Our legal experts have even been called upon to assist in drafting state lien laws.
We’re also advocates for the healthcare industry. We have filed several lawsuits that have resulted in favorable rulings for healthcare providers when insurers fail to properly follow the requirements of the lien laws.
Unlike other MVA vendors, our attorneys are fully involved in all negotiations, and our legal fees are included in our contingency rate, even if litigation is required. Other firms charge their clients for lien filing fees, postage, and other expenses that can add as much as another third to their total cost. The Argos Health contingency rate is all-inclusive.
A True Partner
We will review customer-managed care contracts for free to ensure hospitals are properly coordinating benefits for motor vehicle accident claims and that all payers are making the payments they are obligated to make. In addition, we will also review and suggest edits to our clients’ assignment of benefits form to enhance prompt payment directly to the provider from all available sources.
We’ve developed proprietary predictive analytics models that allow us to quickly determine if an MVA claim is likely to result in reimbursement. This can help us when working with a hospital to decide whether it makes sense to allow a timely filing deadline for a commercial payer to pass to pursue an MVA settlement to the end. At the front end of the process, our software can identify claims that should be immediately submitted to another payer or the patient. By making the determination as early as possible, there is a better chance for the hospital to receive payment on the claim from the proper source.
We’re Complex Claims Experts, Not Just MVA Experts
Argos Health offers other complex claims services besides motor vehicle accident claim revenue recovery, allowing a hospital to centralize the management of multiple types of challenging claims with a single vendor if desired.
Many clients recognize the advantage this provides. An MVA claim may start down one path and end up being paid by any number of payers. Once we are referred an MVA or other complex claim, we’ll work with the appropriate payers until all revenue is recovered.
A Focus on Patient Satisfaction
A victim of a motor vehicle accident is very likely suffering from both pain and confusion related to the insurance process. We’ve spoken with thousands of patients in this circumstance, and we realize their concerns and needs. We patiently explain the process and help them to understand how a small amount of cooperation can mean a quick resolution and no out-of-pocket expense related to their medical care.
We can demonstrate prior success in resolving complex MVA and other TPL claims. Ask us for references.
A Road Map for Simplifying Motor Vehicle Accident Claims and Maximizing Revenue Recovery
Download our white paper to better understand how the odds are stacked against the provider when it comes to MVA claims since almost all such claims involve legal issues unrelated to the care of patients.
The white paper covers the following topics:
- An overview of the MVA claim payment process
- A description of the challenges hospitals face when pursuing motor vehicle accident claims
- The impact of the registration process on MVA reimbursement
- The importance of state lien laws
- How coordination of benefits affects MVA reimbursement
- Why attorney involvement in the negotiation process is key
- And more…
Download the white paper right now and start learning why motor vehicle accident claims are some of the most complicated for a hospital to address.
Click here to download our third party liability / motor vehicle accident revenue recovery service sales sheet.
What does it cost to get started with your service?
We have no implementation fees, and we perform our work on a contingency basis.
Do you require a client to provide a minimum volume of MVA claims?
We have no minimum claim volume or client size requirements. Depending on its location, a small hospital may have a large number of motor vehicle accident claims. At the other end of the spectrum, we work with large health systems, as well.
Do I need to find a place for Argos staff to work at my hospital?
Absolutely not. While other vendors place staff at their client hospitals, our claim assignment logic means that we’ll identify the right claims to work automatically. Our team won’t be taking up space at your facility, complicating the registration process, or asking patients additional financial questions when they are in a painful and stressful situation after an accident.
How do you recover such high reimbursement for MVA claims when we can’t?
Several reasons. We employ dedicated teams for each complicated step in the process and can apply more resources to getting these complex claims paid than any hospital can reasonably be expected to. Payers, plaintiffs’ attorneys, and insurance adjusters know the Argos team are experts in the MVA claim process and are less likely to throw up common roadblocks when dealing with us. Finally, our attorneys work with our clients to review their assignment of benefits and other key documents to ensure the hospital secures its rights to payment at the very start of the revenue cycle.