As a revenue cycle leader, you know managing workers’ comp claims is a process rife with complexities, legal nuances, and regulations that vary from state to state. Workers’ comp claims can be tedious, complicated, and labor-intensive. They live up to their designation as complex claims.
Manual processing of claims is prone to human error and can lead to discrepancies, delays, denials, and potential revenue loss. In a technology-driven world, many revenue cycle leaders are faced with a question: Should we purchase workers’ comp software, or should we outsource our workers’ comp claims?
The decision ultimately depends on factors such as your revenue cycle team’s resources, expertise, and specific needs. Let’s dive deeper.
What is workers’ comp software?
Workers’ comp software is designed to help hospitals and healthcare organizations streamline workflows and automate the process of managing workers’ comp claims.
Most software solutions on the market today offer a platform for managing various aspects of the process, such as claim intake, documentation, bill review, processing, tracking, reporting, etc. Some features and functionalities typically found in workers’ compensation software include:
- Claim intake and reporting: Software allows hospitals to efficiently document information related to workplace injuries or illnesses.
- Document management: Workers’ comp software enables hospitals to keep track of documentation associated with claims, such as medical records, incident reports, witness statements, and correspondence with insurance carriers.
- Tracking and monitoring: Many software solutions provide tools for tracking the status of claims throughout the process.
- Reporting and analytics: Revenue cycle teams can generate various reports and analytics to gain insights into claim trends, costs, outcomes, and performance metrics.
Although investing in workers’ comp software can give your revenue cycle team autonomy to tailor workflows and processes to your hospital’s specific needs, there are drawbacks.
For example, the implementation process can be difficult and time-consuming. Implementing new software also requires staff training to ensure proper usage to maximize the software’s benefits and your investment. This can be even more difficult if your team lacks the specialized expertise required to effectively manage workers’ compensation claims.
There’s also the potential for technology becoming outdated or requiring ongoing maintenance. Your hospital may have to make substantial investments in upgrades or replacement solutions to stay up to date on the ever-evolving regulatory requirements and standards associated with workers’ compensation.
5 Reasons you should outsource your workers’ comp claims
Hospital revenue cycle teams are often constrained by limited resources and time. While investing in software may appear to be an attractive solution, it’s important to consider the advantages of outsourcing your workers’ compensation claims to a specialized vendor. Key benefits include:
1. Expertise and Specialization
Specialized vendors bring deep knowledge of workers’ compensation claims, including jurisdiction-specific rules and regulations. They understand the nuances of local and state laws, payer requirements, and industry practices, ensuring your hospital secures the maximum reimbursement.
2. Scalability
Specialized vendors can adjust resources and processes to match your hospital’s fluctuating claim volumes, unlike in-house teams limited by staffing or expertise. Outsourcing also frees your staff to focus on core responsibilities, enhancing overall efficiency and performance.
3. Risk mitigation
When you entrust your complex claims management to the experts, you mitigate the risks associated with compliance errors and regulatory penalties. Talk about peace of mind!
4. Comprehensive expertise
When you work with a specialized vendor, you’re not limited to the capabilities of a single software solution. You get a broad range of services that go beyond claims processing to include legal support, managed care, clinical reviews, utilization review, appeals management, and more.
5. Access to advanced technology
When you outsource your workers’ comp claims or other complex claims to a specialized partner, you benefit from cutting-edge technology and software tools for claims management – without the tech investment.
Decades of intelligent automation and expertise – one powerful platform
At EnableComp, we got our start with workers’ comp claims more than 25 years ago. With more than 1,000 clients nationwide and more than 21 million claims processed, we have a wealth of claims intelligence. We aren’t just a vendor – instead, we’re your “department down the hall,” offering the resources and infrastructure needed to help you get the most out of your workers’ comp claims.
When you partner with EnableComp, you don’t have to make an additional investment in new technology. Instead, you benefit from e360 RCM ®, our intelligent automation platform.
This means you get to tap into our infrastructure of innovation and expertise with automated workflows; built-in reimbursement modeling; automated denials management features; automated underpayment identification; embedded payer requirements that are updated in real time; and robust analytics.
Our e360 RCM® platform helps us:
- Electronically file claims at a rate 10 times faster than the industry average, meaning you get higher reimbursements with fewer delays
- Offer monthly client reporting, including process improvement, ROI, analysis, and best practice improvements
- Stay on top of the most current workers’ comp fee schedules for all 50 states — so you don’t have to
- Minimize compliance risks and maximize efficiency
Contact EnableComp today to learn more about how we can help you with your workers’ compensation claims.
