Medical Reimbursements of America. Get Paid MORE for Accident Claims.

Transcription

1 Medical Reimbursements of America Get Paid MORE for Accident Claims.

2 1 Now, there s a better way to manage Accident Claims. Accident Claims Management

3 2 3 Reimbursement Pressure is Accelerating. The Pain of Accident Claims. Reimbursement pressure continues to rise. Hospitals are seeing Total Cost of Collections for hospital business offices is typically less than dramatic reductions in payments due to mandatory cuts in government 3%. The majority of claims are clean, with first pass success of more spending, continually changing rules of commercial payers, and overall than 70% thanks to technology-based RCM solutions and standardized uncertainty of healthcare reform. Hospital leadership has never been electronic transactions for eligibility, claims submission, claim status, and under more pressure to reduce costs to make ends meet, and the payment and remittance management. challenge of identifying new revenue to counteract this pressure is overwhelming. Non-Automated Revenue Cycle Accident Claims Today, hospitals are facing the twin burdens of Medicare and Medicaid cuts stipulated by the Affordable Care Act (ACA) Patient Access (No Pre-Reg) Coding Claim Generation Clearing House Primary Payer Health Secondary Payer Health Tertiary Payer Health Patient Billing and Payment Self Pay/Bal after Ins estimated at more than $150 billion in reductions over the next Automated Billing and Payment Process 10 years. Frost & Sullivan 4/17/13 Primary Payer NoFault or WorkComp Secondary Payer Commercial Health or Liability Tertiary Payer Government Health Moody's predicts that hospitals will be challenged to grow revenue in pace with expense growth, noting that virtually all revenue sources are under pressure. Moody s.com 4/11/13 MRA can Help. For nearly 15 years, MRA has helped hospitals improve reimbursement by focusing on accident claims recovery, and our AcciClaim solution has never been in greater demand. We understand the complex challenges associated with this niche of the revenue cycle, and our customers gain significant financial improvement as a result. Manual Billing and Payment Process Unfortunately, Accident Claims are the exception. They are 100% manual and are extremely painful to manage, with Total Cost of Collections of more than 10%. There is no predictability, no pre-registration or scheduling, and no electronic transaction standardization for Accident Claims. They require difficult coordination between multiple non-standard payers, and they lack RCM technology solutions for denial and underpayment management. In spite of this pain, there is good news: When managed correctly, Accident Claims offer the highest reimbursement rate of any category!

4 4 5 Get Paid More. Medical Reimbursements of America (MRA) has been exclusively focused on improving reimbursements for health systems and hospitals since Our industry knowledge, combined with an innovative, technology-driven culture and the most talented team in our industry, positions MRA as a recognized leader in Accident Claims Management. Our HFMA Peer Reviewed solution, AcciClaim, gets hospitals paid more for Motor Vehicle and Workers Compensation accidents. Accident Claims Represent a Small Percentage of Overall Claims But Represent Significant New Revenue Potential All Other Financial Classes 97% The Opportunity When managed correctly, accident claims, generate the highest reimbursement rate of any financial class. Many are paid at 100% of gross charges. 3% Accident Claims The Problem Unfortunately, accident claims are very difficult to manage correctly. They are 100% manual, with no pre-registration, no standardized electronic transactions, and no automated RCM technology for denial, underpayment, or billing and payment management. $20,000,000 $15,000,000 $10,000,000 $10.3M $0.7M +50% $16.8M $2.2M (Liability) $4.0M (No Fault) They require difficult coordination between multiple non-standard payers. $5.1M $5.6M Accident claims are fraught with compliance challenges. The Solution Hospitals do not typically have the internal resources and expertise needed to obtain maximum payment from these claims. They do now, with AcciClaim. $5,000,000 $0 $4.5M Before AcciClaim Auto WorkComp $5.0M After AcciClaim Health Representative Annual Performance Improvement for $3B Health System

5 6 7 Peer Rated Solution. MRA has been delivering reimbursement optimization for hospitals since AcciClaim, the new and improved Accident Claims Management solution from MRA, is driven by an advanced technology platform and is the first Accident Claims Management solution to have earned HFMA Peer Review designation. The AcciClaim solution is comprised of three service lines: AcciClaim Auto provides comprehensive Day 1 billing and management of Motor Vehicle Accident claims, identifying and recovering all available benefits from Property and Casualty (No Fault), Liability, and Health Insurance sources. AcciClaim WorkComp provides comprehensive Day 1 billing and management of Workers Compensation Accident claims, removing administrative headaches by correctly submitting clean claims and aggressively defending against improper underpayments and denials. The Benefits. AcciClaim provides immediate relief from the reimbursement pressures being felt across all other payment sources, with benefits that include: Higher Reimbursement More Revenue Less Headaches Compliance Integrity Exclusive Industry Rating for AcciClaim HFMA's Peer Review process is designed to provide healthcare financial managers with an objective third-party evaluation of products and services used in the healthcare workplace. The rigorous, 11-step process includes a panel review made up of current customers, prospects who have not made a purchase, and industry experts. Peer Review status of the product or service and its performance claims are based on effectiveness, quality and usability, price, value, and customer and technical support. AcciClaim Zero identifies and recovers lost revenue from previously written-off (i.e. zero balance) Workers Compensation and Uncompensated Care accounts, using proprietary algorithms and data mining techniques to discover previously undiscovered revenue.

6 8 9 The Better Way. Technology AcciClaim s patent-pending technology platform is the first software platform developed specifically for the Accident Claims Management industry: Seamlessly integrate AcciClaim into your revenue cycle. Payment and Remittance Data Seamless integration with existing revenue cycle systems Rules-based engine for optimal reimbursement Connectivity to payers, carriers, attorneys, and other relevant parties Process automation streamlines customized workflow Accident Claims Data Status and Results Patient Advocacy AcciClaim s focus on Patient Advocacy reduces financial trauma for patients through education and through identification of alternative payment sources for their co-pays and deductibles: Accident claims specialists who identify alternative sources of payment for patients Reduced Self-Pay balances which helps both patients AND providers! Dedicated patient call center and web-based patient portal Patient-friendly communications and educational materials Data Analytics AcciClaim s data analytics capabilities provide intelligence needed to (i) obtain maximum reimbursement for Day 1 accident claims and (ii) identify previously undiscovered revenue: Data mining techniques that identify previously undiscovered lost revenue Predictive modeling expertise that accurately projects potential reimbursement lift Proprietary algorithms that provide expected value to identify underpayments Comparative analytics that measure and help improve performance Proprietary data set that contains more than $5 Billion in historical accident claims data Reporting and Support AcciClaim serves as a seamless extension of the business office, leveraging technology to provide the reporting hospitals want and the customer service they deserve: No Fault Insurance Carriers Patient Advocacy AcciClaim Registration Portal AcciClaim Patient Portal AcciClaim Patient Call Center Strict Cooordination of Benefits Liability Insurance Carriers AcciClaim Auto Health Insurance (Optional) Day 1 ED Registration Training and Support Accident Investigation Insurance(s) Verification Accident Billing and Payment Management Lien Protected Settlements AcciClaim Provider Portal Self-Service Tools Strict Administrative and Legal Compliance Employers and TPAs AcciClaim WorkComp Work Comp Carriers Bill and Payment Review Executive Reporting delivered through a dedicated Account Manager State of the art data exchange (HL7, EDI, XML, CSV) Web-based reporting portal for self-service convenience: - On line performance reporting and account status - Automated status updating of hospital billing systems Experience and Expertise MRA has remained 100% focused on Accident Claims Management since 1999: Nation s largest submitter of accident-related medical claims to the Property and Casualty industry National footprint serving all regions of the US In-house legal team with comprehensive knowledge of Federal and State rules and regulations Long term relationships with Payers, Carriers, Adjusters, Attorneys, and Employers The Results: Higher Reimbursement More Revenue Less Headaches

7 10 11 AcciClaim Auto AcciClaim Auto provides hospitals with a comprehensive, single-source solution for management of Motor Vehicle Accident claims. These claims represent a small percentage of total claims typically about 2%. Yet, when managed correctly, this portion produces unusually high reimbursement rates, providing an important opportunity to offset the reimbursement pressure felt from virtually all other payment sources. AcciClaim NoFault maximizes reimbursement from Motor Vehicle Accidents by investigating the accident, helping the patient open a claim, and coordinating and managing all No-Fault Insurance activity including billing, follow-up, payment management, and compliance management. Provides new sources of payment from No-Fault Insurance Typically collects >50% more from No-Fault Insurers Eliminates the hassle of No-Fault Insurance including time-intensive interactions with Property & Casualty adjusters and paper-based billing AcciClaim Liability provides an outsourced legal team that maximizes reimbursement from liable parties. MRA legal professionals use a national network of adjusters and attorneys and a proprietary knowledge base to manage the entire process including securitization (lien filings and letters of protection), billing, case management and follow-up, negotiation, settlement, and final payments. Collects significantly more dollars from liable parties Eliminates the hassle of identification, verification, lien filing, negotiation, and settlement of liability cases Transforms Self-Pay claims into Secured Liability claims (averaging >65% reimbursement rate from previously Self-Pay claims) AcciClaim HealthPlus provides hospitals with the knowledge and evidence to confidently bill health correctly for Motor Vehicle Accidents. AcciClaim provides the payer-specific and state-specific instructions, along with the documentation required, to compliantly bill each claim. AcciClaim also offers optional outsourced health billing for providers that do not want to perform health billing of accident claims in-house. Provides 100% compliance with Medicare Secondary Payer, Medicaid, and other Payer requirements Provides payer-specific and state-specific instructions; plus custom content and documentation required to prevent denials Ensures prompt payment and eliminates missed timely filings Offers optional comprehensive billing, including Health, for a single-source solution to all accident claims billing

8 12 13 AcciClaim WorkComp AcciClaim WorkComp relieves the burden of getting appeals and settlement negotiations in compliance with Federal paid for Workers Compensation Accident claims. and State laws. With nearly 15 years of legal experience serving These claims require extensive resources and hospitals in all regions of the country, AcciClaim WorkComp expertise to get paid correctly, yet typically has the knowledge and experience to obtain the maximum represent less than 1% of claim volume. Hospitals benefits available. often lack the resources to work them correctly, resulting in lost revenues and higher AR days. AcciClaim WorkComp Hospitals can rest assured that each Workers Compensation Accident claim is managed correctly, resulting in maximum reimbursement and minimal administrative burden. AcciClaim WorkComp is a comprehensive solution, with more claims submitted cleanly on the front-end, and with aggressive management of all underpayments and appeals post-adjudication on the back-end. Collects more dollars by more accurate bill submission Collects more dollars by more effective denial and underpayment management Eliminates time-intensive interactions with Property and Casualty Adjusters, Employers and Third Party Administrators Reduces AR days by navigating the administrative laws governing Workers Compensation in all states AcciClaim WorkComp ensures compliance and timely filing by meeting all State & Federal regulations and Workers Compensation carrier & TPA requirements. Comprehensive Workers Compensation Claims Management includes patient interviews, Workers Compensation identification and verification, and coordination and management of every claim. Provides an outsourced legal department using experienced MRA attorneys and paralegals Leverages a proprietary database of Employers, Carriers, TPAs, and Property and Casualty Adjusters nationwide Incorporates proprietary algorithms that calculate expected value, and then compare actual payments to expected value and effectively identify underpayments AcciClaim WorkComp optimizes reimbursement by working directly with Workers Compensation carriers, Third Party Administrators, and Employers to manage all billing, denials, underpayments,

9 14 15 AcciClaim Zero AcciClaim Zero provides analytic services that identify and recover new revenue from claims previously written-off by hospitals. AcciClaim s patent-pending technology delivers new revenue from two hidden sources: AcciClaim Zero-Uncompensated Care Hospitals provide uncompensated care to patients through charity programs and through delivery of services later deemed to be uncollectable. Some of these patients later file personal injury lawsuits against third parties for motor vehicle accidents, assaults, slip and falls, defective products, mass tort and other liability actions. Hospitals are rarely able to identify these personal injury lawsuits. Even when they do, they face cost-prohibitive processes to assert liens and recover payment from these cases. AcciClaim Zero-Uncompensated Care provides proprietary data analytic services that identify personal injury lawsuits that are filed after the patient account has been written off. The same technology used by Property and Casualty carriers to identify subrogation claims is now available for hospitals to identify these hidden lawsuits through two unique services: (1) access to a proprietary database containing several million personal injury lawsuits covering nearly 80% of the US population, and (2) proprietary data mining technology that searches this database to identify specific lawsuits that match specific patient accounts with reimbursement potential. Since lawsuit filings do not include plaintiff s personal information such as address or social security number, sophisticated data mining techniques have been developed that match these lawsuit filings with potential uninsured patient accounts. Once lawsuits with reimbursement potential are identified, the hospital s legal rights are secured by liens or notices of intervention. Settlements are then negotiated and recovered from Liability Insurance carriers prior to the settlement of the patient lawsuits. AcciClaim Zero-WorkComp AcciClaim Zero-WorkComp identifies and recovers underpayments and denials from Workers Compensation claims that have been categorized as paid-in-full, but which actually have additional reimbursement available. Proprietary algorithms identify previously undiscovered revenue based upon contractual discrepancies, usual and customary or fee schedule charge discrepancies and billing errors that result in reversible underpayments. Once improper underpayments and denials are discovered, the claims are re-adjudicated and the new revenue is recovered for the hospital. Financial Benefit There is no work required by hospitals to benefit from these two hidden sources of new revenue, other than providing historical Uncompensated Care and/or Workers Compensation claims data. Every dollar identified and recovered by AcciClaim Zero is a dollar that the hospital would have never discovered because either (1) the patient lawsuit proceeds would have remained unknown, and thus been paid directly to the uninsured patient; or (2) the Workers Compensation claim would have never been re-adjudicated. As a result of AcciClaim Zero, hospitals receive significant new revenue from services that have already been performed: AcciClaim Zero delivers new revenue from closed patient accounts, with Zero Effort Zero Headaches Zero Risk Zero Fixed Costs

10 16 17 Get Started. MRA is proud of our long history helping health systems and hospitals recover more reimbursements from Accident Claims. We hope you will want to learn more about our AcciClaim solution, and are confident that you will like what you see. To learn more about our services, please AcciClaim Path to New Revenue ROI BEGINS us or give us a call. And if you like what you see, we will commit to rapid turnaround times to get additional reimbursements flowing to you as quickly as possible. BAA Signed/ Performance Data Received AcciClaim Performance Analysis TM Decision to Move Forward Services Agreement Completed Implementation /Connectivity Planning Implementation/ ED Observation Staff Training 6 WEEKS Introduction 3 WEEKS TODAY 3 WEEKS

11 18 Monthly Webinars. Experienced MRA representatives regularly share the latest challenges in hospital reimbursement management along with presenting AcciClaim, our new and improved Accident Claims Management solution. Contact us today to schedule a personal webinar or us at info@mraresults.com to learn more. Complimentary Performance Analysis. MRA is able to accurately predict the additional reimbursement available for your hospital based upon your actual performance data. To see how much additional revenue we can recover for your facility, contact us today for your complimentary AcciClaim Performance Analysis. To Learn More, Contact Us at Medical Reimbursements of America 7105 Moores Lane, Brentwood, Tennessee info@mraresults.com medicalreimbursements.com 2013 Medical Reimbursements of America

12 Medical Reimbursements of America 7105 Moores Lane Brentwood, Tennessee (Toll free)