ClaimTECH Blog - MVA Claims Resolution & Beyond

Revenue Cycle Solutions: Who Deserves the Money?

Posted by ClaimTECH on Mar 16, 2017 10:45:20 AM


When looking for fair revenue cycle solutions and dealing with complex MVA claims resolution, oftentimes the two primary questions are:

  • Who deserves the money?
  • Who really gets paid?

Today, we’re going to dive into these two questions and shed some light on who wins and who loses in the current MVA claims process.

First, Where Does the Money Come From?

When an injured claimant is rushed to the hospital due to a motor vehicle accident (MVA), they have the right to demand examination and treatment from a certified trauma center. This begins a costly process: The patient travels to the closest trauma hospital by ambulance (~$1,500), followed by a neurological exam from the attending Emergency Room physician (~$1,800) and perhaps also a CT scan of the head, neck and abdomen (~$4,000/each). A trauma cart of hermetically sealed medical instruments may also be rolled in, and could cost between $2,500-$6,500. Doctors act quickly to take care of the patient, but in these serious moments, little attention is given to the costs being accrued.

In the aftermath, the injured party is hit with expensive hospital bills; this is only the beginning. Additional specialty care, such as chiropractics or physical therapy, may also increase the bill for the injured party.

Who Deserves the Money?

The hospital deserves to get paid for the work they did to save the life of the claimant. The costs of examinations, treatments and services can grow to be extremely high, and in order for hospitals to offer this care up front, they must be reimbursed after the fact.

The injured claimant also deserves a compensation based not on their medical bills but on the severity of their injuries once pain and suffering is factored in. When a claimant is in a motor vehicle accident, they look to their insurer (or the responsible party’s insurer) for help paying their bills per their policy limits. Pain and suffering, however, can be an additional payment on top of quantifiable medical costs.

But Who Really Gets Paid?

In the current system, the party that tends to collect somewhere around 30-40%% of the total billed charges (in effect raising the payout of the insurer and decreasing the reimbursement rate of the hospital) is often the plaintiff attorney representing the injured claimant.

Plaintiff Attorneys attempt to expand the costs of the medical bills with the promise of giving the injured claimant a higher payout. However, the real result is a prolonged negotiation, oftentimes requiring litigation, which gives the injured claimant no bigger of a payout. Instead, the attorney fees increase at the cost of both the claimant and the insurer (which ultimately raises the costs of our country’s auto insurance overtime) and reduces the amount of money hospitals receive for their services (which ultimately increases the amount hospitals must charge for care).

In order to deal with these complex claims, hospitals often look to outsource their revenue cycle solutions management to outside companies, who also take a cut for their services, averaging additional fees from 10-25%% on dollars recovered.

The remaining balance is split between the hospital and the injured claimant. In the current process, hospitals average a 27% reimbursement rate on their services.This just isn’t right.

ClaimTECH Is The Revenue Cycle Solution

ClaimTECH is a revenue cycle solutions tool specifically for the processing of MVA claims to help direct money to the people who truly deserve optimal reimbursement. By leveraging a cloud-based technology fused with legal precedent, ClaimTECH prevents litigation which ultimately results in bigger reimbursements for healthcare providers while maintaining reasonable costs for insurance carriers. The result is improved overall costs for hospitals and insurers while still getting the injured claimant back into the state they were in prior to the accident. It’s a win-win for the claimant, the hospitals, the insurers, and the industry as a whole.

This powerful platform is built specifically to allow carriers and providers to collaborate directly with each other, circumventing the middlemen, while reducing financial waste in the process.

To learn more about the power of ClaimTECH, request a call with one of our experts today:

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Topics: Revenue Cycle Solutions