In 2019 alone, motor vehicle accidents cost the U.S. healthcare system approximately $463 billion. Unfortunately, it’s unlikely the hospitals treating injured patients recovered even a quarter of the reimbursement they were due.
Why? Because hospitals significantly underestimate the true number of MVA-related services they provide within their facility.
Motor vehicle accidents are third-party liability claims, which are likely to be covered by auto policies or other liability carriers. As such, MVA claims require an entirely different revenue recovery process to manage and bill multiple payers and to navigate an evolving legal landscape. When patient services are not accurately identified as MVA-related, the hospital is often walking away from the most appropriate payer for those claims.
Typically, hospitals 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 has proven to be 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 are able to reliably communicate their MVA status, much less provide third-party insurance information.
Failure to swiftly identify and begin working MVA claims results in two critical issues:
- Missed Deadlines
Each payer has its own filing deadline schedule, and there will be filing decisions to be made based on the merits and progress of any auto claim. Further, many states have hospital lien statutes that allow hospitals to receive reimbursement directly from settlement funds. Those, too, have strict filing deadlines.
- Depleted Funds
Auto insurance, such as first-party medical payments coverage (Medpay) and/or personal injury protection coverage (PIP), is typically carried in finite amounts, which auto insurers often pay on a first-come first-served basis. Hospitals that wait 30 days to bill may find they’re last in line for reimbursement. When there are several providers sharing a limited pool of funds, the claims process must move faster.
The Solution: Automated Claims Assignment
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 begin searching 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. One MVA patient, for example, may have four or five different insurance companies that could potentially pay for care.
Based on our experience, hospitals with a focused MVA strategy may achieve as much as 70% reimbursement. A comprehensive approach to identifying and billing the correct third-party payers can:
- reduce denials and underpayments
- increase revenue
- provide access to funds that hospital PFS teams were completely unaware of
How many MVA claims are your PFS teams missing? Use our free online performance analysis tool to find out: https://complexcaims.com/mva-claims-performance-analysis/
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 process and advocate fiercely for proper payment. Learn more here: https://complexclaims.com/motor-vehicle-accident-claims