As a revenue cycle leader, you know managing workers’ compensation claims is a process rife with complexities, legal nuances, and regulations that vary from state to state. Workers’ compensation 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’ compensation software, or should we outsource our workers’ compensation 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’ compensation 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’ compensation 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’ compensation 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There’s also the potential for technology becoming outdated or requiring ongoing maintenance.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:
- Expertise and specialization: Specialized vendors have in-depth knowledge and expertise in workers’ compensation claims. They live and breathe complex claims and can ensure your hospital is getting the maximum reimbursement you’re owed.
- Scalability: Unlike in-house revenue cycle teams that are plagued by staffing issues and limited expertise, specialized vendors can scale their resources and approach based on your hospital’s needs, ensuring flexibility in adapting to fluctuating claim volumes. At the same time, such outsourcing empowers your team and enhances the work they’re doing by freeing them to focus on what they do best.
- 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!
- 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.
- 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 & Expertise. One Powerful Platform.
At EnableComp, we got our start with workers’ compensation claims more than 20 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 — and you 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
Learn more: Download our eBook
To learn more about workers’ compensation claims and why outsourcing is a smart choice for your organization, download our free eBook Taking On Workers’ Compensation Claims: A Healthcare Provider’s Guide to the Process and Its Risks. Or contact us to schedule a consultation.
