We have written a few articles about the broken claims settling system and occasionally we’ve put the blame on the “middlemen.” We’ve found that one solution to the MVA claims process is not to disregard the current industry, it’s to find ways to work Revenue Cycle Management (RCM) technology into the process!
Claims automation sounds fast. It sounds worthy of 2017. But it sounds like a fantasy when you think of the current third party MVA claims resolution process.
Today, most third party MVA claims are settled manually. They begin with a motor vehicle accident patient’s information being either typed into a computer or scribbled onto a sheet somewhere. Then Risk Managers in the healthcare industry begin the exhausting process of trying to track down the responsible party, file liens and negotiate reimbursements for their hospital’s medical services.
Why third party liability MVA medical claims are financially eating hospitals and auto insurance carriers alive.
No one saw it coming...Who could have guessed that third party liability MVA medical claims would become increasingly problematic and woefully expensive for the hospitals that treat accident victims and the national auto insurers that pay for it?
Medical costs are rising significantly, and this is particularly true for hospital trauma centers. MVA medical claims range from $500 to $50,000, even for simple, low impact accidents, a.k.a “fender-benders.”
In our experience, the claims industry lacks a crucial aspect of business: Relationships. Healthcare providers rarely speak directly with insurance carriers, and when they do, a sense of cooperation seems to be missing. There is simply too much ‘distance’ in between healthcare providers and insurance carriers.
To imagine providers and carriers building a relationship together is a bit farfetched. At the core of the exchange is a negotiation. Both sides try to settle the claim to the benefit of their respective employers, so from the beginning there is a barrier. Plus, due to size of the industry, rarely does the same adjuster work with the same claims representative on more than one claims resolution.
Hospital Administrators, it’s time to roll up your sleeves and address the elephant in the room: How do I improve hospital cash flow management? Where is there money to be saved? And where do I even start?
First, you start with a revenue stream that often gets riddled with inaccuracies, inefficiencies and opportunities: third party MVA claims. It may not the biggest chunk of revenue for your hospital, but optimizing the third party MVA claims process can free up cash immediately, not to mention increase your reimbursement rate going forward.
There is never a “normal” situation when referring to the third party MVA claims settlement process today. The industry is so incredibly complex and the costs and reimbursements are so incredible large, that each MVA claim is a unique case. Every claim has the potential to result in a time-consuming mess that could take hundreds of days to settle while only reimbursing hospitals pennies on the dollar for their services.
Topics: MVA Claims
We know what you’re thinking: How could a cloud-based, MVA claims technology platform truly improve society? Well, here’s your answer:
By infusing modern claims technology into an outdated claims settlement process, millions of people every year in the insurance and healthcare industries will be given the tools to provide more efficient settlements, higher reimbursements for doctors and hospitals, and ultimately, lower insurance premiums for the public.
If you’re an adjuster or a manager of adjusters, and you’re looking for greater efficiency in the MVA claims process, this blog is for you.
We’ve spoken to your colleagues to discover what a “day in the life” of a claims adjuster looks like and we’ve interviewed industry experts and healthcare providers to try to better understand what pain points you’re experiencing, all in the hopes of optimizing the claims settlement process for you.
A patient in the Emergency Room is in critical care when they come off the ambulance. Doctors don’t know who the patient is or where they came from -- the EMT says only that it was a motor vehicle accident. Doctors rush to their side and diligently work to save the patient. A job well done.
But now comes the messy part --
According to national data from the Centers for Disease Control and Prevention, Motor Vehicle Accidents (MVAs) represent about four percent of most hospital emergency room visits. While they may be a small percentage of visits, they represent one of the largest pain points for healthcare providers, in regards to difficulty in collections of payment - all due to the complex nature of MVA claims.