Time for a New Workers’ Comp Strategy in “20Gr18”

Posted January 4, 2018 by Hamilton Bowman

Along with ringing in the New Year, many people resolve to make lifestyle changes (or resolutions) to accomplish certain goals and make it great. There is no reason why Revenue Cycle executives shouldn’t use this time to re-examine their business line strategies. Workers’ Comp (WC) claims are notoriously difficult to manage for several key reasons. As you look at your complex claims goals for 2018, here are a few subjects to consider.

Endeavor to go “paperless” in 2018

Are you getting tired of managing the overflowing stack of UBs representing unfiled WC bills? If so, then 2018 should be the year for you to go paperless! No more printing copies of medical records, itemized statements, and other paper attachments to go along with your bills…you can submit these bills electronically. In 2017, EnableComp submitted over half of our WC bills and required attachments electronically – well above the industry average. Keep in mind that electronic submission is only half the battle…you also need to know how much you should be paid.

Hard to calculate and payers tend to underpay

As you know, WC reimbursement is complex, as the fee schedules vary by state, and are different for inpatient bills and outpatient bills. These fee schedules change regularly, some even yearly, and PPO contracts and other nuances make these claims difficult to calculate. Our experience shows that almost 2/3 of WC bills are sent to the incorrect payer location, and once received at the proper payer, P&C payers are unfamiliar with medical claim processing, which leads to higher denial rates for this financial class. Some hospitals have processes in place to estimate reimbursement and generate appeals when underpaid, but if you don’t, it could be time to re-evaluate your strategy.

Significant Margin opportunity even though low % of revenue

WC claims typically represent less than 3% of a hospital’s revenue, but require a much higher percentage of resources and effort. Also, most state fee schedules dictate a reimbursement rate 2x-3x that of Medicare, leading to a higher margin rate than other financial classes. So, you want to maximize revenue for WC claims and achieve best possible reimbursement to avoid leaving money on the table.

Set best practice objectives to benchmark and measure

Now could be the best time to evaluate your WC results. For example, are you managing your AR over 90 days to less than 20% of the total? Are you collecting at the best possible reimbursement rate for WC claims? Are you getting paid within 60 days? If you identify a need to outsource these claims, you could get the added benefit of more collections, plus the ability to reallocate your staff to other larger financial classes. At EnableComp, we have set the industry standard best practices benchmarks for WC revenue cycle and will gladly share these benchmarks with you for comparison.

Let us know if you would like to partner with us to evaluate your strategy to make it a “20Gr18”!