Motor Vehicle Accident (MVA) claims can be a complicated and time-consuming task for healthcare providers. Why are MVA claims complex? The complexity of MVA claims stems from several factors, from determining liability and assessing damages to negotiating with insurance companies and understanding intricate legal regulations.
These cases require a holistic focus on enhancing the overall patient experience, not only encompassing medical documentation and billing procedures but also navigating the legal and insurance landscapes. A specialized approach is needed to alleviate the financial burden on patients, streamline billing practices, and simultaneously optimize revenue generation, all while upholding the highest standards of patient care.
What Makes MVA Claims Complex?
Navigating MVA claims poses a formidable challenge for healthcare organizations, requiring revenue cycle teams to have a keen understanding of legal intricacies and various insurance policies. Key factors contributing to the complexity of MVA claims include:
- Multiple parties, including the drivers of the vehicles, their passengers, and witnesses, may be involved — often leading to disputes over who is at fault and difficulty gathering evidence.
- Different insurance policies may apply to certain aspects of the claim, such as personal injury, property damage, or uninsured/underinsured motorist coverage.
- Injuries can be serious, requiring extensive and long-term medical treatment and rehabilitation.
- MVA claims are subject to specific laws and regulations that can vary from state to state and require thorough knowledge and expertise to interpret.
- Documentation requirements may be extensive and difficult to obtain.
- Coordinating with healthcare providers, specialists, and experts may be necessary to obtain all required information and documentation.
- Skilled negotiation and understanding of insurance practices are crucial for dealing with insurance companies that may try to deny or minimize payouts.
- Submitting claims and any supporting documents timely and correctly, as well as following up until the claim is resolved, can be time-consuming.
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Schedule a ConsultationHow Do Motor Vehicle Accident Claims Work?
Understanding how MVA claims work is essential for healthcare providers to provide high-quality care to patients involved in accidents.
- Conduct a thorough assessment to diagnose and document injuries accurately
- Collect detailed information, including police reports, witness statements, and any available evidence
- Verify insurance details of the patient and any other involved parties
- Generate and submit bills to the appropriate insurance companies
- Monitor the progress of the claim, keep track of any communication from insurance companies, and respond to requests for additional information or clarification
- Continue to monitor and treat the patient’s injuries, collaborating with specialists as needed
- Provide updated medical records or reports to support ongoing claims
- Work to understand the reason for the denial and appeal the decision if appropriate
- Work closely with legal representatives if necessary
- Work with the insurance company to ensure that all outstanding bills are paid and any necessary arrangements for ongoing care or rehabilitation are made
Navigating the MVA Claims Filing Process
MVA claims can equate to millions of dollars in annual revenue for hospitals. So, providers need to process these claims efficiently. They are, however, complicated and require a specialized approach to billing and revenue recovery. They often require manual work and detailed knowledge of state-specific regulations. It’s critical to coordinate benefits among first-party liability, third-party liability, and health insurance(s) and to comply with state and federal laws.
For healthcare providers and their revenue cycle management teams, processing MVA claims presents a unique set of challenges. Full payment relies heavily on:
- Collecting detailed information about the accident, including police reports, witness statements, accident claim numbers, dates, and any other relevant documentation
- Ensuring all medical records, treatment plans, pre-authorizations (if necessary), and expert opinions are obtained
- Confirming the insurance details of all parties, taking note of coverage limits and any applicable exclusions
- Verifying and filing the correct insurance billing order
- Ensuring claims are submitted promptly — verifying claim filing deadlines with each insurance company — and with all necessary documents
- Maintaining open lines of communication with all relevant parties, including insurance companies and legal representatives
Preventing MVA Claims Delays and Denials
Because MVA claims tend to be so complex, they can take a long time to be resolved and negatively impact your days-to-pay and other KPIs. Many moving parts are involved in the filing, follow-up, and successful resolution of these claims.
Challenges in the claims filing process that may cause denials or delays include:
- Incomplete or inaccurate information or supporting documentation
- Inefficient claims management or failing to meet required submission deadlines
- Disagreements over fault or insufficient evidence to support a case for who is at fault
- Inadequate insurance coverage to fully compensate for the damages incurred
MVA claims are at high risk of denial due to strict and complicated filing requirements. Even if you think you have completed all the necessary steps, the ambiguity of state laws and the unique requirements of different insurance companies can leave you empty-handed. That’s why it’s a good idea to bring in professionals well-versed in handling the complexities of these claims effectively.
EnableComp understands the challenges of MVA claims and is prepared to take them over at any stage of the claims process. Our team of experts will use proprietary technology to review your claims and take the necessary steps to expedite accurate payments. We have plug-and-play solutions with claims clearinghouses that support the electronic submission of bills and attachments, typically improving days-to-pay significantly. We are swift and tenacious in our follow-up with payers. Our claims management platform integrates with your EMR system to securely transfer claims data. EnableComp is a partner with the resources and expertise to navigate how MVA claims work from registration to reimbursement, freeing up your team to focus on less complicated claims and, of course, your patients.
