With the rise in patient responsibility, partly due to the rise in high deductible health plans, there has been a noticeable decrease in patient collection rates. These patient collection rates are attributed to a large portion of a hospitals’ overall revenue. When looking at ways to improve the revenue cycle and maximize reimbursements, hospitals need to look at the entire process, not just the back office. This starts as early as the patient registration process.
One of the first experiences a patient has with your facility is during the registration process. When a patient walks through your doors, there’s a good chance they are feeling various emotions including fear, anxiety, and confusion. In this fragile state, they are handed a clipboard with multiple pages of questions, hospital policies, and HIPAA verbiage – none of which are written in layman’s terms that make it easy to understand. This makes for the beginning of a poor patient experience. Happy patients are more than likely going to be more willing to address their financials more quickly. And this all begins at the first point of contact – the registration desk.
For workers’ comp claims specifically, the registration process is more invasive than a “check the box” process. There are many nuances that go into registering a patient who has been injured, or fell ill, on the job that are outside of the clinical purview. Fundamentally, the patient registration process is not only the beginning of patient care at the hospital, but also the beginning of the revenue cycle. This is exactly why the intake staff needs to get the registration process right, the first time.
2019 marked the third straight year that the total recordable workplace incident rate remained at 2.8 million, with nearly 300,000 workplace illnesses and injuries being treated in Emergency Departments across the nation. From a claims standpoint, they all had one critical thing in common: workers’ compensation coverage was the primary and only payer in the mix. This means that hospitals that fail to identify work-related claims at the point of registration are in for a long road paved with delays, denials, and takebacks. Optimizing patient registrations needs to be the priority focal point of a workers’ compensation registration strategy. The first step to optimizing this strategy starts with training your registration staff to ask these five essential questions:
1. Is the injury/illness work-related?
Don’t assume that patients will know to assert the information on their own, or that the workplace connection will become obvious during the treatment process. Once you know the incident is work-related, determine if the state in which the employer/patient resides requires you to file an injury report. Depending on the state, the deadline for completing the form may be as short as 24 hours. There’s no time to waste.
2. Where do you work?
Unlike traditional health insurance, patients are unlikely to know the workers’ compensation payer that is responsible for their company’s coverage. Therefore, it’s imperative to ask patients where they work. Specifically, you will need to document the employer’s name, address, main phone number, and the full name of the person responsible for being your main contact at the employer. Expect some hurdles, and be prepared to follow preauthorization policies, employer direct-pay programs, and regulations that apply to the payer and to the state workers’ compensation program.
3. What happened?
The injury form requires you to provide not just a summary of the patient’s current medical condition but also a summary of how the injury occurred, where it occurred, the date in which it occurred, and whether this is your first visit, or a follow-up visit for this specific injury. Be prepared to collect a full description of what caused the injury or illness, an explanation of why it’s work-related, as well as full contact information for the injured worker.
4. What is the name and contact information for the person responsible for workers’ compensation at your place of employment?
As previously stated, unlike traditional health insurance, most patients will not know the workers’ compensation payer that is responsible for their company’s coverage. Therefore, it is imperative that you document the name and contact information of the patient’s employer correctly.
5. Who is your Group Health Insurance carrier?
This information needs to be obtained during the registration process in the event the patient’s work comp payer denies the claim. When obtaining your patient’s health insurance information, remember to ask them about the policy holder because sometimes the patient is covered under their spouses or parent’s policy.
Once you have optimized the patient registration strategy, the next priority should be implementing a strategy to work towards hitting your financial goals with the greatest impact on your organization. At EnableComp, we are a “department down the hall” for your workers’ compensation claims. From patient registration to reimbursement, our proprietary claims management software, Enforcer360, is the most efficient provider-based comprehensive workflow engine in the marketplace, delivering your claims to the right payer, for the right amount, at the right time. With over 22 years of experience, we have a long track record of success – collecting 100% of net expected reimbursement in an average of 60 days or less. Our technology has built-in reimbursement modeling, underpayment identification, and embedded federal/state/company reimbursement rules, which provides our clients the highest yield and best-in-class outcomes in less time. Every additional claim makes our AI “smarter” and enhances our data-driven RPA leading to a real bottom-line impact for providers! Let us maximize your workers’ compensation claim revenue while you focus on improving the care your patients deserve.