Overhauling Claims Management
A recent claims management overhaul designed to enhance communication between claims adjusters and Republic Services Inc. personnel throughout the United States, has yielded positive results in less than a year. The new claims management initiative serves as the foundation for much broader company goals to reduce claim costs.
Thanks to the new approach to claims management, Republic Services hopes to lower claim costs by returning injured employees to work sooner, closing claims faster, and ultimately, analyzing claims data to initiate safety and loss prevention programs to prevent injuries in the future.
Less than a year ago, Republic Services contracted with CCMSl, a third-party claims management provider, to provide risk and claims management services in an effort to improve claims processes and communication. Together, the two entities engaged in a collaborative effort to improve Republic Services’ claims management program.
As the corporate claims manager at Republic Services, Dwayne Hart works with CCMSI and the attorneys that handle litigation. He is also involved with ensuring that claims are accurately handled in accordance with stringent internal and external guidelines. Each division is allocated funds for the costs incurred from workers compensation or auto claims, which account for 95% of Republic Services’ exposure. It is not always easy to determine what a claim might cost without quality communication between the claims adjuster and Republic Services personnel, he says.
“We wanted to improve communication and establish 24/7 access to claims data so more people within Republic Services had access to the information,” says Hart. “Without communication between the claims adjuster and local Republic Services people, our staff didn’t always know all the details of a claim and what the adjuster was doing behind the scenes.”
By not knowing all of the details surrounding a claim, Hart maintains, it is more difficult to return injured employees to work, especially in a modified or light-duty position. “The more information you have, the better off everybody is going to be, and the quicker the injured person gets to a doctor, gets well, goes into modified duty and then is transitioned to work in their regular position,” says Hart.
Together, CCMSI and Republic Services engaged in an eight-month initiative to improve claims and risk management. The first step to accomplish better claims management was to improve communication between adjusters and safety personnel on the local level. “One of the things CCMSl offered was access to claims through their iCE portal,” says Hart. iCE is a web-based proprietary claims-reporting and dataanalysis software developed by CCMSl exclusively for clients. It was initially developed to offer more benefits than other applications on the market, including state and OSHA reporting components. Because it is owned, managed and continuously improved inhouse at CCMSI, the software can be customized to meet the individual needs of clients, according Charles Wattigny, vice president of national accounts at CCMSl.
Together, Republic Services and CCMSI worked to adjust the iCE reporting portal to better suit the specific needs of Republic Services. “We discovered we needed to be able to report and track both auto liability claims and workers comp claims, while linking all costs to our allocation system,” says Hart. The new portal allows Republic Services to collect all information regarding accidents and injuries-making claims management more efficient.
“We’ve gained more aggressive claims handling because everyone is working together,” says Hart. Thanks to electronic submission and improved communication, claims are closed sooner and more efficiently. But, he says, that is just the tip of the iceberg.
“We are concentrating on the modified, light-duty position and why it is beneficial,” he says. “It gets them back to work using muscles, as opposed to sitting at home deteriorating. It’s a win-win scenario.”
Before, Republic Services managers simply did not have access to all of the information they needed to return people to work. Now they do.
Haley Jorgensen is the owner of Public Image, a public relations and marketing firm in Ripon, Wisconsin.
Claims management
With MFX RiskVault, all participants in the claim management process can dispense with the vast amount of paperwork, which for years has taken up significant time and space compounded with retrieval limitations. Consolidating all documents and data associated with a claim in a single, secure location liberates time that can be used in judgmental work, creating a real benefit to customer service, indemnity, expense reduction and efficiency.
To learn more, call 866.639.6399 or visit www.mfxfairfax.com/riskvault.
Claims management
Sedgwick Claims Management Services, has opened an office in Canada, Sedgwick CMS Canada Inc., the company has announced. It is the company’s first international location for the U.S. claims and productivity management services provider. Sedgwick CMS Canada is serving clients from its new offices in Mississauga, Ontario, a suburb of Toronto.
“Sedgwick CMS has for many years provided for the Canadian liability claims management requirements of U.S.-headquartered international companies through our network of correspondent and remote arrangements,” said David A. North, president and CEO of Sedgwick CMS, in a statement. “We now look forward to expanding our direct involvement with such clients and to establishing the groundwork for business relationships with Canadian companies,” he also said. Louise A. Rivett will manage Sedgwick CMS Canada, North also said. The phone number for Sedgwick CMS Canada is (905) 678-2451.
Claims management
CSC provides claims, risk and policy management systems, and services for self-insured organizations, TPAs, health-care providers and insurance carriers. CSC’s solutions process, manage and analyze claims while supporting an organization’s efforts in controlling legal costs, assessing bodily-injury liability, identifying potential fraud and checking for OFAC compliance.
CSC’s RISKMASTER is the only totally browser-based system that provides a single solution for managing all risk and claims processes. POINT IN is designed for midrange carriers and EXCEED for large insurers. To find out more about CSC’s solutions, please call 800-345-7672.
Claims management
Ensure secure access to information, standards compliance, and promote processing efficiency and accuracy with MountainView Software’s ClaimZone Reporter[R] and ClaimZone Enterprise Edition[R]. A complete claims reporting and management package designed for risk managers, claims adjusters and IT managers, ClaimZone tools are J2EE compliant and feature 128-bit encryption and user-defined access to ensure security.
Web-based, ClaimZone tools offer the convenience of accessing, processing and sharing data via the Web. Contact us at 888-533-1122 for a demo or visit us at www.mvso.com.
Healthcare Claims Management Made Easy
If you’re a claims manager or adjuster workers comp, auto, health or disability insurance, one of the scarcest resources you have is your time. When you have complex and costly cases, your time gets eaten up adjudicating claims and consulting others for opinions. If you find yourself in positions where you’re stretched too thin, a great way to extend your capabilities and to move your most difficult cases through your organization is to use the services of an Independent Review Organization. Independent Review Organizations are dedicated to providing medical decision support to claims payers of all types on healthcare benefits or on medical benefits related to specific treatments. An Independent Review Organization provides an external, objective medical review service for insurance carriers, Third Party Administrators, and other types of payers. Independent Review Organizations help them allocate their resources effectively and provide decisions about the approval and denial of treatments.
Independent Review Organizations are typically accredited by a URAC (at least the good ones are). They provide a panel of external peer physicians in all specialties and sub-specialties who are capable of providing standard or expedited reviews of health care cases by determining their medical necessity, standard of care, whether they are experimental or investigational, whether they indicate an appropriate length of stay in hospitals and other types of questions that a doctor must review.
The Independent Review Organization always matches the case with a specialist having the same background as the referring specialist. Independent Review Organization specialists are always board certified, licensed and in active practice. This insures is that you will be able to use the same expert knowledge to make your claims decision as was originally applied to the treatment being considered. It allows you to speed up your claims decision making, eliminate unnecessary medical treatment, reduce premium costs for disability and workers comp and ensure that your claims resources are being allocated to members who deserve the care, and not those who don’t.
So if you’re a claims manager and you’re not using an Independent Review Organization today to evaluate claims inside your organization, consider one.
7 Reasons To Use Practice Management Software
Managing a medical practice is very complex but it doesn’t have to be that way any more. Medical practice management software has been around for years but progress in technology have made running a medical practice even easier. It’s now almost considered a must-have tool to compete and become more efficient. Are you still not sure about installing it? After reading the 7 reasons why you should install it below , you will have a better idea as to what this powerful software can do.
1. Patient Medical Records
With every patient comes a mountain of patient data that needs to be captured, stored, and easy to find and sort through. Practice management software makes it easy to do everything you need regarding patient medical records including: storing scanned images and documents, demographic information, insurance information, financial history of the patient, and appointments. Most medical practice management systems make it easy to enter the information and easy to navigate as well as provide other services such as alerts, referral tracking, memos, tickler to-do lists, and the ability to email patients. This in and of itself makes the investment worth it.
2. Scheduling
Medical practice management software allows you to control your schedule and set up your appointment book just the way you like it. They routinely have features such as referral information, co-payment amounts and checkout, alerts for outstanding balances, and allow you to search for open times rapidly. You can even set up an appointment wait list if necessary. The nice thing is all of this is integrated into the patient medical record portion of the software. Talk about a time-saver!
3. Charge Capture & Checkout
Are you looking to manage the billing process with more ease? These features allow you to bill and bring together payments efficiently, process claims with more accuracy, and track charges all along the way. By the time patients check out, all charges are calculated at the front desk and the exact amount is known and return visit is set. Again all of this is integrated with the patient records so that makes it all the more efficient and, yes, powerful.
4. Medical Claims Management
From posting to payment, you will be able to keep track of all your claims. This feature gives you the ability to receive faster reimbursements with eClaims and eRemittance, use whichever claim forms you require, review claims, view unbilled claims, view exclusions, and keep track of all reports from carriers and the clearinghouse.
5. Medical Billing & Collections
If you ever wanted to lower labor costs, this is the software solution that will do so. Stuffing, printing, labeling and sending bills to patients takes a lot of time out of the work day. Instead of paying someone to do all of those things, you can use your medical practice management software to organize those things and make them much more simple. The collection process is also simplified and it becomes easier to organize all of your important data.
6. Reports & Office Management
This common feature allows you to create customizable reports from patient data, to collections, to billing, to appointments, to an accounts receivable summary. Some of the medical practice management software packages allow you to create Microsoft Word letters for collections or other needs. If you are looking for a way to measure the efficiency of your operation, this is the way to receive that data.
7. Multiple Offices
How convenient would it be to have access to your practice management system anywhere you need it? Since a number of the practice management software packages are web-based you are given that option. This makes trying to organize your system much more simple, especially if you have multiple offices which all need to stay in constant communication with each other.
Even though the health care industry has been slow to implement information technology into its system/[c] any medical practice will benefit from using it. Hopefully these 7 reasons give a better understanding of why it is so important that all medical practices have practice management software installed.
ROI Analysis for an ASP Practice Management System for the Medical Industry
Billing errors can cost your organization thousands of dollars. This section analyzes manual billing pitfalls, costs to your organization, and proven ways to recover lost revenue.
Most billing errors can be eliminated prior to the submission of your claim. Managing these errors with little labor (i.e. people) intervention increases your overall profit. Relying on simple billing/claims software and/or personnel to remember specific billing requirements will result in an increase of denials and delayed cash. Instead, invest in billing software that has the capability of building your specific billing rules into the system. The system should allow for multiple claim forms. Your users should be able to view claim forms online, and reformat the claim online if necessary. The system should have the ability to automatically submit clean claims to the Payer, without human intervention. And most importantly, the system should contain your Payer specific rules for billing.
For example, some Payers have different billing requirements for the same procedure code. Your system should have the ability to generate a claim specific to the applicable Payer.. If your system does not have the capability of managing these types of rules, you are relying on personnel to catch the requirement up front and edit the claim prior to submission. Or, the claim will be submitted to the Payer and then denied for missing information.
Let’s examine the cost of both processes (manual versus system built rules). If you are relying on a manual or simple billing/claims system, your process will typically be as follows. A claim is generated and reviewed by your office staff. The Payer requirement states the specific procedure code must be submitted with a letter of medical necessity. Your office staff must remember this requirement (in addition to the other multitudes of billing requirements Payers create). The charge is $500. The claim is mailed to the Payer without the LMN. Twenty days later a denial is received from the Payer, stating the claim is not eligible for payment due to missing information. At this point, your staff will either remember what the missing information is, or more than likely contact the Payer for explanation. Your staff will then retrieve the LMN and resubmit the claim to the Payer with the LMN attached.
How does this cost your organization? Let’s assume the initial charge is $500. Begin subtracting the personnel cost to review the claim up front, review the denial, contact the Payer, correct the claim, resubmit to the Payer, and then follow-up with the Payer regarding payment. On average, this would entail approximately 2 hours of personnel costs. Plus, the $500 receivable has been delayed at least thirty days, resulting in a lower margin to your organization.
Investing in billing software that allows you to build in Payer specific rules will increase your margin almost immediately.
The software should provide flexible billing cycles, the capability to build in rules for Payer specific billing requirements, flexible claim formatting, missing element tracking, online reformatting, and a multitude of other user friendly functions to assist your personnel in billing.
How will this benefit your organization? In the above example, your $500 profit is reduced by 8-10% for personnel costs. That is then reduced by another 5% due to the delay in collection of the receivable. Conservatively, your margin is reduced by 15%. Multiply that by the number of instances this is currently occurring in your practice. You can see how quickly your margin erodes, and cash flow is delayed.
The cost of a Medical Billing System is usually dependent on the size of your practice and number of concurrent users. For a small practice, the cost could be less than $2,500 to install. Taking the above example into our analysis, your return on investment would be seen very quickly. Investing in a solution will be paramount in increasing your margin and cash flow.
In addition to the features mentioned above, your medical billing software should provide your organization with Revenue Management reporting, an on-line patient financial folder, automatic charge posting, and much more!
Centralized Workflow Management for Outsourced Electronic Medical Billing Service and Software
The reduction of accounts receivable is key responsibility of billing function in a medical practice. This article compares traditional (distributed) billing function with centralized workflow management. It shows that centralized workflow management yields significant advantages over the distributed approach in terms of the ability to manage accounts receivable. However, it also requires significant investment in process, technology, and personnel training.
Benefits of Centralized Workflow Management for Medical Billing
Centralized workflow management is superior to traditional billing operations management because it enables continuous billing process improvement and avoidance repetition of errors, while reducing dependency on specific individual billing knowledge. The billing process improves systematically along the key performance dimensions, including payment amount and its timeliness.
Centralized workflow management accomplishes such important benefits using a two-pronged approach based on formal encoding of billing and compliance knowledge and a computer program to apply the knowledge and manage claim followup lists.
As encoded billing knowledge base grows, the accuracy of the claims and the speed of the process increases. Additionally, the staff can spend more time focusing on exceptions, while an increasing majority of claims is processed automatically.
Moreover, centralized workflow shares its billing rules across all providers and billers. Therefore, errors discovered and corrected for one provider will be avoided in the future for all of the providers using the system.
What is Workflow?
Workflow is defined as a sequence of actions performed on a claim until it is paid. Centralized workflow management must quickly separate “clean” claims from potential failures, submit clean claims to payers, and flag potential failures for correction. Workflow must also track the correction process, ensuring its integration with other sources of failures and successful completion. Finally, workflow must facilitate meticulous documentation of every step to enable continuous improvement and learning from experience.
Failed Claim
A failed claim is a claim that is flagged by the workflow system upfront as an invalid claim, is rejected by the payer after submission, or is not properly adjudicated within 30 days — in other words, a claim that requires followup.
Workbench
Centralized workflow manages such followup lists of failed claims using workbenches. A workbench is a list of failed claims assigned to individual biller or operator. Such individual assignment of work enables continuous and individual performance tracking and improvement.
Activity Triggers
In medical billing operation, the followup lists and “to-do” lists of individual actions for each failed claim constantly change. To manage multiple to-do lists, the centralized workflow system has activity triggers. Activity triggers are the heart of task automation; they help determine what’s important. Activity triggers match up promises with events and manage individual work queues in the process.
Remembering to call a payer or a provider weeks after a phone conversation when payment or claim clarification was promised requires a billing clerk to sort through their call-on-receipt folder several times a day. Activity triggers eliminate the reliance on personal memory and enable communication between individual workbenches. They are the strings that tie billing activities together. When Mary from the provider’s office updates the claim with correct ICD-9, the system needs to be aware that the claim is ready for validation, and John in billing office needs to know so he can review it again, if the validation failed or schedule its transmission to the payer.
Task Automation
Centralized workflow eliminates paper-based steps. Like a relay team passing the baton, the billing staff members electronically pass along their work without delays. Instead of printing, faxing, and following up with an e-mail or a phone call, all tasks arrive complete with supporting documentation. Rather than thumbing through reams of paper reading scribbled notes, billers receive onscreen reminders when tasks are due.
Process Monitoring
Centralized workflow also simplifies process monitoring. Providers and managers use dashboards to review key indicators. Like activity triggers, dashboards help focus personnel on what is important from high-level perspective. They show key business information that tells us if we are paid more or less over time, if our charges are going up or down, and if our followup policies are too lenient. They tell us whether we are heading in the right direction and act like lighthouses to keep us off the shoals. When we see that warning light, we can drill into the details and take corrective action.
Summary
The key difference between vericle-like centralized workflow management and traditional approaches is that a centralized workflow guides the operator in terms of claims that need followup. There is no need to manually look up reports to analyze data and select claims for followup. Vericle-like approach ensures followup consistency and timeliness.
The Simple Process Of Making An Accident Claim For Compensation
Making an accident claim for compensation is a very simple process. Many people do not realise how simple it really is. There are just 3 basic steps:
• The first one is you find a suitable lawyer who is willing to take on your accident claim on a no win no fee basis
• Filling out the form which describes your accident and the names and addressed of any possible witnesses
• Then sit and wait for your compensation award.
That may sound too simple but it really is. The lawyer does everything for you and once the ball is rolling you may get contacted by you layer asking you for further information but this can be dealt with over the phone quickly and easily. The lawyer might need doctor’s notes but the lawyer will be the one to sort this out. You just need to tell your Lawyer all of the facts and he will do it all for you. If doctor’s notes are required you may have to find the money to pay for these. The costs for these are normally around £100 which can be found from insurances if you have trouble finding this money. Either way the money gets reimbursed once the accident claim is complete.
Many people think it’s wrong to claim compensation for accidents and believe it is only adding to the compensation culture that is so talked about. But what needs to be realised is that if people don’t do anything about accidents the same accidents can happen time and time again cause more and more people grief. But if for instance you trip over some uneven pavement and then report it to the local council and put a claim in for compensation the local council HAS to sit up and listen. You can be sure that they will sort the uneven pavement out so another accident doesn’t happen.
You will need to make sure you get a good solicitor to take on your case. It is wise to find a solicitor that has years of experience in dealing with accident claims. With the internet you can now find hundreds of websites that offer ‘no win no fee’ agreements for accident claims. The tough part is sifting through them to find a good legitimate one that will put your best interests at heart and not look at your accident claims as just another claim for them to make hundreds of pounds from. If you can find a company that are regulated by the Ministry of Justice and is authorised to undertake regulated claims management activities under the provisions of the Compensation Act 2006, then you know they are a legitimate company. Also if the lawyers are willing to show their faces on their website then this proves they have nothing to hide. Not many claims companies are willing to do this.