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In-House or Outsourced? Best Practices in Complex Claims Revenue Cycle Management

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Successful revenue cycle management focuses on two things: solving cash flow problems and generating the most amount of net revenue possible. Accounting for a small percentage of most medical facilities’ overall receivables, complex claims related to personal injury cases can add in a layer of complexity to revenue cycle management.

According to BlackBook “Complex claims (typically motor vehicle, workers’ compensation, injury, catastrophe and general liability cases) present a mixture of challenges for a hospital’s billing and collections staff, who are usually not experienced in dealing with non-traditional payers.”

Most practices have software platforms and experienced staff dedicated to handling federal/state and commercial receivables. However, it is not typical for a medical practice to have dedicated staff with the legal and insurance knowledge necessary to navigate the medical lien process often associated with personal injury claims.

“Outsourcing complex claims allows hospitals to tap into an infrastructure that can successfully recover this often lost source of revenue”
Doug Brown, Managing Partner of Black Book

Personal injury claims are frequently processed manually due to lack of information at the time of service. These complex claims can be time consuming, taking years to receive payment. And sometimes, these claims are so tricky to navigate that medical practices often give up on collecting on them entirely resulting in lost revenue.

81% of hospitals state they lack the specialized talent to resolve very difficult claims according to Black Book’s 2016 RCM Survey. “In fact, when compared to traditional claims, complex claims were written off at a significantly higher rate last year” said Brown.

How Can You Maximize Reimbursement of Medical Liens?

At Elite Medical Receivables Solutions, we understand the financial challenges that medical providers face while waiting for their personal injury medical liens to pay out 2-3 years after medical services were rendered. We can help you by buying your receivables soon after you provide care to a personal injury patient. We also purchase medical receivable portfolios associated with personal injuries.

Elite assumes the risk and responsibility when we purchase your personal injury medical lien receivables, which allows your team to focus on the majority of your claims from federal/state and commercial insurance. Our team of legal and insurance professionals manage the cases from patient care to settlement. And, with one of the highest collection rates in the United States, we recover a higher percentage of claims and get you paid faster.

We are knowledgeable in the nuances of insurance law and the management of lien filing. We negotiate higher settlements from insurance carriers and plaintiff attorneys to get you the best reimbursement for the care you have given your patients.

Benefits of Outsourcing Personal Injury Claim Management

In today’s environment of healthcare reform and decreasing reimbursement, medical lien recovery can be a welcome influx of much needed cash flow. However, managing these liens can take a lot of time and expertise to manage effectively.

Working instead with a leader in personal injury medical lien management can allow you to enjoy the revenue stream without having to dedicate resources to the time-consuming tracking of all the cases. And most importantly, we increase revenue for your practice in the first 90 days. Our expertise allows your team to focus their time on what matters the most: more productive interactions with your patients.

Ready to Learn More?

Submit an inquiry or call us at 888-242-4012 today to see how we can help you develop a robust lien management strategy.

Category: Insights
Last Updated: OnNovember 16, 2021