Workers’ Compensation Complex Claims Revenue Recovery Service
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Workers’ compensation claims can be some of the most labor-intensive and complicated for providers to bill and collect on. Would you like to achieve any of the following?
- Faster payment on workers’ compensation claims
- Reduced workers’ compensation A/R and bad debt
- Less time disputing denied workers’ compensation claims with commercial insurance companies
- Proper workers’ compensation contractual adjustments
- Elimination of staffing concerns related to workers’ compensation
- No need to maintain knowledge of workers’ compensation rules and regulations
- Improved patient satisfaction
If so, Argos Health can definitely help.
Our Solution
Kevin Theiss
Vice President Revenue Cycle, Western Reserve Health System
Argos Health handles workers’ compensation claims from start to finish, as an extension of your business office.
The workers’ compensation revenue cycle begins at registration. When a claim is identified as a work-related injury, most states require a form to document the injury. This form may be called a “First Report of Injury,” “First Report of Occupational Injury or Illness,” “Report of Occupational Injury or Disease,” or something similar.
If our client desires, Argos can complete this form, eliminating the need for hospital or physician office staff to handle this task. In some states, submitting this form must be done within 24 hours to protect revenue.
Although the form is often simple, it may not be easy to obtain all of the information required. One of the more difficult tasks is identifying the proper employer. This may sound surprising, but the official business name of the company may not match the name under which the company does business (the one the employee is familiar with).
We can find the employer using proprietary databases, state resources, and patient contact when necessary. We’ve spoken with thousands of patients in this situation, and we understand their concerns and needs. Ultimately, we identify the correct payer for each workers’ compensation visit and register the insurance properly so that bills drop correctly.
At this point, we also identify companion accounts. These are claims related to the referred account that have not previously been identified as workers’ compensation claims and may otherwise be written off. It’s not unusual for Argos Health to recover an additional 15-20% of workers’ compensation revenue for our clients because we take this extra step.
From this point on, we monitor claim status and work with your clinical team to address any retroactive authorizations as needed.
Importantly, we manage the 35% of workers’ compensation claims that result in denials. No matter the reason for the denial, our team takes a step-by-step approach through proven algorithms to identify and solve the problem.
Once a payment is posted, we carefully review the EOB to confirm all line items were correctly paid following the relevant fee schedule or payment methodology. Any zero or partial payments identified will continue to be worked until the bill is paid in full.
All Argos Health activity is noted directly in your system by our staff. We don’t use canned or automated notes, so you’ll know exactly what’s happening with each claim and its unique circumstances. We work with every major EHR vendor, including Epic, Cerner, Meditech, and many others.
When you use Argos to manage your workers’ compensation claims, you’ll have a full team of experts 100% focused on these complex claims. This means you don’t need to worry about what will happen if your in-house workers’ compensation expert leaves or is promoted.
With Argos managing your workers’ compensation claims, you also won’t need to dedicate internal resources to maintaining knowledge of your state’s workers’ compensation laws and regulations, which are frequently updated. If your hospital is near a border with another state, staying up to date on regulatory changes is even more difficult.
Having someone entirely focused on your workers’ compensation business means issues that can impact revenue such as CDM problems, irregular volume trends, and unusual charging patterns are identified before they can impact A/R.
Finally, sometimes, what initially looks like a workers’ compensation claim turns out to be a motor vehicle accident, Medicare, Medicaid, or commercial insurance claim. Argos has the ability and experience to accurately bill and collect from any payer that is responsible for paying a claim, and we do so until the work is done.
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 workers’ compensation claim was in hearing status for five months until finally being disallowed. Argos Health billed the patient’s commercial insurance and followed up weekly for status. The insurance company denied the claim for no prior authorization for the inpatient stay. Argos Health appealed with the necessary workers’ compensation documentation. That appeal was denied for medical necessity. The Argos Health team reviewed all the medical information for the inpatient stay and determined the second denial could be appealed. We prepared a formal appeal letter and included all pertinent medical documentation, including nurse’s notes.
The claim was paid after eleven months of follow-up, leaving less than $100 in patient responsibility.
Workers’ Compensation Claim Revenue Recovery Service Video
Watch the video below to learn more about the workers’ compensation revenue recovery process.
Financial Considerations
Director of Finance
300+ bed hospital
Argos understands that the financial teams at hospitals and health systems are under pressure to keep their accounts receivable under control. With the manual effort and paper communication required for many workers’ compensation claims, it’s not unusual for the A/R to increase to a conspicuous level.
Our processes help to reduce workers’ compensation A/R and bad debt in many ways:
- We have a team that is 100% focused on workers’ compensation, so these claims are reviewed quickly and if needed are moved to another payer or to self-pay, giving our clients the best chance to pursue reimbursement from the correct source
- We keep your workers’ compensation insurance plan list updated, so there are no delays in assigning a claim to the proper plan upfront and no need to re-bill to the correct payer later
- We have efficient processes set up with larger workers’ compensation managed care organizations and insurance carriers to process claims faster
- We automate our interactions with payers whenever possible, so we know exactly when a claim is ready to move to the next step in the process
- We manage the proper workers’ compensation contractual adjustments for the claims we work under our clients’ preferred guidelines, so the A/R for paid claims is accurate
- We can manage your workers’ compensation provider enrollment information to eliminate write-offs due to credentialing issues
We recover revenue on workers’ compensation claims based on a contingency pricing model. This means our motivation is more revenue for our clients, not merely getting through an assigned work queue. Allowing our experts to pursue your workers’ compensation claims means that any existing business office staff that were previously focused on workers’ compensation claims can turn their attention to government and commercial accounts and collect more revenue in those areas.
What Makes Argos Different?
Given the specialized knowledge and resources required to properly collect all the revenue a hospital deserves on workers’ compensation claims, they are a perfect candidate for outsourcing. What makes Argos different compared to other vendors who provide workers’ compensation services?
Expertise and Experience
We’re experienced with workers’ compensation systems across the country. We have a demonstrated ability to move into new states based on our work in a variety of monopolistic (state as payer) and traditional programs. We’re also experts in the very complex federal workers’ compensation systems related to the Department of Labor and the Department of Energy.
A True Partner
We will gladly provide free education sessions for your staff and clinical teams to help them better understand the workers’ compensation process and their role in it. We find that this small investment in our time can make the process smoother and much less confusing for everyone involved.
Technology
We automate our processes whenever possible. Workers’ compensation claims involve many parties – the employer, the employee, payers, state agencies, etc. Each step in a state’s process may include waiting for one of these parties to complete a task before the next step can be taken toward payment. Whenever possible, Argos automates these tasks and status checks so we can keep workers’ compensation claims moving as quickly as possible to a final resolution.
We’re Complex Claims Experts, Not Just Workers’ Compensation Experts
We offer other complex claims services besides workers’ compensation revenue recovery, allowing a hospital to centralize the management of multiple types of challenging claims with a single vendor if desired.
A Focus on Patient Satisfaction
A workers’ compensation patient is very likely suffering from both pain and confusion related to the insurance process. Unlike in commercial or auto insurance claim situations, a workers’ compensation patient is unlikely to know their employer’s workers’ compensation insurance information. We patiently explain the workers’ compensation process and help them to understand how a small amount of cooperation can mean a smooth insurance process, allowing them to focus on their recovery.
One of the performance metrics our staff closely monitors is “how many patients did we help this month?” as opposed to “how many claims did we process?”
Proven Success
We can demonstrate prior success in resolving complex workers’ compensation claims. Ask us for references.
Workers’ Compensation White Paper
Hospital Workers’ Compensation Claims: Strategies for Success
Download our white paper to understand better why each step in the revenue cycle related to a workers’ compensation claim involves multiple challenges.
The white paper covers the following topics:
- An overview of various workers’ compensation systems in the US
- The importance of the registration process in workers’ compensation claim resolution
- The connection between coding and denials
- Why billing for workers’ compensation claims is unique
- Strategies for increasing workers’ compensation recoveries
- And more…
Download the white paper right now and start learning why workers’ compensation claims are some of the most difficult for a hospital to collect.
Workers’ Compensation Sales Sheet
Click here to download our workers’ compensation revenue recovery service sales sheet.
Frequently Asked Questions
What does it cost to get started with your service?
We have no implementation fees, and our work is performed on a contingency basis.
Do you require a client to provide a minimum volume of workers’ compensation claims?
We have no minimum claim volume or client size requirements. We work with clients ranging from critical access hospitals to large health systems.
Do I need to find a place for Argos staff to work at my hospital?
Absolutely not. All of our work is done by US-based staff in our offices.