The current medical claims processing rate rarely allows for healthcare providers to receive 100% reimbursement for their services from the insurance carrier. That means the doctors and hospitals that provide the medical treatments to care for injured motor vehicle patients will never receive their full payment.
How Low Can the Medical Claims Processing Rate Go?
Unfortunately, there isn’t a limit to how little healthcare providers can get reimbursed for their treatment and service bills. Some states use a loose “Rule of Thirds” theory to judge how much the healthcare provider, the plaintiff’s attorney and the injured claimant should receive. In this scenario, each party only gets 33% of the settled claim.
What Needs to Change to Boost the Medical Claims Processing Reimbursement Rate to 100%?
There’s a gauntlet of obstacles and hurdles healthcare providers must navigate through in order to process medical claims. Even if a provider does successfully reach the finish line, more often than not the reimbursement rate will have dwindled to hardly recognizable levels. We dive in below:
1. Improperly Classified Medical Claims
Inaccuracies in the recording of the claimant’s information can cause unnecessary reimbursement problems. In our estimates, healthcare providers miss out on classifying a third party VMA claim up to 11% of the time because they are unaware that the patient they're treating is MVA related. in all the chaos of saving lives and providing medical care, hospitals miss out on opportunities to request reimbursement from insurance carriers.
2. Determining the Responsible Party
Third party MVA medical claims oftentimes include multiple insurance carriers. They debate responsibility, and in the process, healthcare providers cannot identify the correct carrier to request reimbursement from. They may label it “Self-Pay” and eventually even write it off as bad debt, seeing little to no payment.
3. 209 Days to Settle on Average
It takes on average 209 days to process a single medical claim. Hospitals can attempt to speed this process up by hiring revenue cycle management companies who can try to track down the responsible parties and properly identify the correct classification, but every day these claims go unsettled, the rate of reimbursement plummets and the chance of settling the claim edges closer to nonexistent.
4. Middlemen In the Medical Claims Process
The longer the claims settling process takes, the more opportunities there are for plaintiff’s attorneys and revenue cycle management companies to get involved. Once wedged into the process, they skim percentages off the top of the claim, resulting in less and less reimbursement for healthcare providers.
5. Claimant Pockets the Bill
If the insurance carrier does agree to reimburse the healthcare provider, it’s not always guaranteed that the payment ever makes it to the hospital. Third party MVA claimants occasionally pocket the payment and decide not to pay the hospital for the bill. The provider ends up with a reimbursement rate of zero.
There are simply too many obstacles in the way of a successful third party MVA claims reimbursement. In order to combat this gauntlet, the healthcare industry needs a seamless way to organize, accelerate and improve the MVA claims settling process. That solution is ClaimTECH.
What Is ClaimTECH?
ClaimTECH is a powerful new platform that connects healthcare providers with insurance carriers to make settling third party MVA claims more efficient, resulting in higher payouts for hospitals.
By creating an opportunity for providers to communicate directly with carriers, hospitals can request payment from carriers while bypassing the gauntlet of middlemen, inaccuracies and improper classification.
To learn more about this disruptive claims technology, request a call with a ClaimTECH expert today: