In managing the revenue cycle for complex claims for a healthcare provider, particularly within the personal injury sector, any number of things can go wrong. Claims denial or reductions can cause revenue loss. Incorrect patient information can lead to substantial issues down the road.
These revenue cycle management challenges are amplified when dealing with Letters of Protection (LOPs) and third-party liability cases. Unlike standard insurance billing, personal injury claims involve legal complexities that can stall cash flow for months or even years.
Gain’s SaaS-based, AI-enhanced third-party servicing platform has all the tools and resources you need to address the specific revenue cycle management challenges that come up during your revenue cycle management. From the moment patient information is collected and entered into your records to the final settlement payment.
Let’s take a closer look at 6 medical provider RCM for complex claims challenges, and how Gain can help.
1. Collection Errors in Personal Injury Cases
Collection issues often arise from not following up on unpaid claims, not appealing denials in time, or failing to collect payment from settlement proceeds. These errors can significantly impact a healthcare provider’s cash flow and financial health. In the realm of personal injury, revenue cycle management challenges often stem from a lack of diligent follow-up on case status with attorneys.
How Gain Can Help: Gain collects, on average, nearly 900 basis points more than providers do when they self-service their own medical lien accounts. This reflects Gain’s effective collection process, which includes follow-ups on unpaid claims, timely appeals on denials, and efficient patient payment collection methods.
Our medical lien collections and management services transfer the responsibility for negotiation and collection to the Gain team, significantly reducing collection errors and improving cash flow for healthcare providers. This addresses the core revenue cycle management challenges associated with lost files or missed deadlines.
2. Tracking Medical Liens (LOPs)
Practice management software systems are not meant to manage Medical Liens, also commonly called a Letter of Protection (LOP). This forces practices to use Excel spreadsheets to track medical liens, which is cumbersome and consumes staff time. Using these manual workarounds is one of the major revenue cycle management challenges that makes it harder to avoid write-offs.
How Gain Can Help: The Gain portal automates the process of tracking medical liens and the progress of personal injury lawsuits with medical lien balances.
By relying on Gain to manage the medical lien, you save staff time and can convert medical liens from a potential loss into increased revenue for your practice. This automation is vital for overcoming complex claims RCM hurdles where manual data entry often fails.
3. Communicating with Attorneys
Holders of medical liens must be in constant contact with attorneys, paralegals, and case managers for case updates, underwriting information, cases, settlement amounts, and timing of payments. The disconnect between medical and legal offices is one of the most persistent revenue cycle management healthcare challenges.
How Gain Can Help: The Gain platform is a single portal where both healthcare providers and attorneys can provide updates, upload critical documents, and send messages. The case management software streamlines the process of communication, improving inefficiencies with your staff, and eliminating delays involved in tracking down information.
By solving these communication breakdowns, we resolve common RCM providers issues, such as trying to figure out who to contact for different needs via phone calls or emails.
4. Judicial Risks and Compliance
Getting payment on a medical lien depends in large measure on what happens inside a courtroom, and healthcare providers may feel powerless to affect the outcome they want. Providers risk not meeting technical requirements for liens, and keeping track of what those requirements are can be a daunting task, as they vary by state.
This regulatory maze is a significant contributor to revenue cycle management challenges. They also risk dealing with the perception that they are in “cahoots” with attorneys or inflating bills for higher settlements.
How Gain Can Help: By using Gain’s platform to automatically track and manage your medical liens and handle related communication and sharing of documents with attorneys, you can significantly reduce your risk.
Gain’s Provider Map locates providers based on the patient’s location, rather than personal relationships. This can help ensure that providers are chosen based on their proximity and availability, rather than any perceived favoritism with attorneys, effectively mitigating revenue cycle management issues related to bias accusations.
5. Insurance Defense Challenges
Defense counsels frequently challenge the independence of doctors, and question the necessity of treatment, the reasonableness of medical bills, and the validity of liens in litigation. They often base this on what they assert is the provider’s bias due to their vested financial interest. This scrutiny is one of the unique revenue cycle management challenges in personal injury, where the information needed to be gathered when seeing personal injury patients who have no health insurance potentially biases a doctor’s professional opinions.
How Gain Can Help: By outsourcing the entire process of servicing medical liens to a third-party platform, you can make such legal challenges moot. This allows you to focus on providing the treatment that is needed to your patients, without having to worry about financial ins and outs of how you will be eventually paid.
In addition to technological solutions, we aim to empower physician practice groups facing ongoing declines in reimbursement rates.
We are leveling the playing field against the sophisticated and powerful third-party liability carriers in healthcare insurance to reduce revenue cycle management loss. Complex claims take on average about 1 and a half years to resolve. Given that not all claims result in payouts, this cap is unsustainable.
As co-founders of Americans for Patient Access (APA), the best practices organization committed to maintaining access to quality medical care for all patients regardless of payor source, we are supporting nationwide lobbying efforts. We help educate legislators on the necessity of access to care for the less advantaged, while ensuring fair reimbursement for providers, addressing systemic challenges in revenue cycle management.
6. Lack of Data-Based Insights
Without data, you can’t reliably forecast how much you can expect to receive in payment, how quickly you can expect funds to be made available, or what your overall flow of revenues should be in a given period or from a particular law firm. In effect, you are flying blind, which is one of the most dangerous revenue cycle management challenges.
How Gain Can Help: Gain’s AI-enhanced platform provides you with the business intelligence reporting necessary to track the progress of cases and the timing of settlements, payoffs, and the resulting impact on cash flow.
Our AI-enhanced reports can inform your decisions on referral sources, case financials, and more. This data is essential for complex revenue cycle managment and accurate forecasting.
Transforming Your RCM
Just about anything can go wrong in your revenue cycle, from lack of data to lost revenues due to medical liens or legal challenges. By helping you to track documents and the progress of cases, communicate more effectively with other involved parties, and access key data and reports, Gain can transform your revenue cycle management for complex claims. We reduce risk while boosting revenues, solving the most difficult revenue cycle management challenges.
Gain provides cash flow solutions for personal injury healthcare providers that traditional billing companies cannot match. Whether it is medical receivable financing for personal injury cases or simply better management, our tools are designed for your success.
Talk to our specialist or request a consultation today.
FAQ
Which services can help providers with complex reimbursement disputes?
Services that specialize in complex claims processing and third-party liability, such as Gain Servicing, are essential. They offer challenges and solutions in healthcare revenue cycle management by handling the negotiation, legal compliance, and lien tracking that traditional billing software misses.
Which of the following is entered into practice management software?
Typically, patient demographics, insurance information, and standard billing codes are entered. However, RCM claims related to personal injury often require specialized data like attorney details, LOP status, and case updates, which are better managed through a dedicated platform like Gain rather than standard software.
What are the top companies offering RCM services for complex healthcare claims?
Companies that offer specialized RCM challenges solutions for personal injury include Gain Servicing. When looking for RCM providers, prioritize those with AI-enhanced platforms and specific experience in medical liens and LOPs.
How to improve revenue cycle management for complex claims processing?
To improve complex claims processing, automate the tracking of medical liens, ensure seamless communication with attorneys, and utilize data analytics to forecast settlements. Addressing these revenue cycle management healthcare challenges requires moving away from spreadsheets to dedicated RCM platforms.
