Motor vehicle accident (MVA) claims present unique challenges and opportunities for hospitals and healthcare providers in their revenue cycle management (RCM). Understanding the vast and varied intricacies of MVA claims—including a multitude of differing state laws and practices—and knowing how best to negotiate terms, can significantly affect a hospital’s bottom line. Let’s explore practical legal strategies and real-world considerations to effectively manage these complex claims in the healthcare revenue cycle.
Understanding Legal Structures and Insurance Coverage
One of the foundational aspects of managing MVA claims is understanding the legal structure in your state. States generally fall into two categories: tort states and no-fault states. In tort states, claims are made against the at-fault party, and drivers are required to carry liability insurance. No-fault states, on the other hand, require drivers to use their own coverage for damages, with claims against the at-fault party limited by certain thresholds.
Insurance coverage in MVA cases typically falls into two main categories: first-party coverage (like Medical Payments or Personal Injury Protection) and third-party liability coverage.
As Josh McVey, General Manager of Motor Vehicle Accident at Aspirion, points out: “It has always been our approach to be a little more conservative here in this area as we try to find our hospital partners the fastest avenue to cash. So, although the patient may have health insurance coverage, we’ve always recommended billing it secondary regardless of whether your state’s law specifically calls out this requirement or not.”
This approach can help hospitals navigate the complexities of different insurance types and ensure they’re pursuing the most appropriate avenue for reimbursement.
The Power and Pitfalls of Hospital Liens
Hospital liens can be a powerful tool for securing payment, especially when treating uninsured patients; however, it’s important to understand your state’s specific lien laws and keep abreast of any changes. Martin Drake, Senior Director of Complex Claims Legal at Aspirion, advises, “Unfortunately, most patients aren’t going to understand this, and this is something that is going to have to be explained to the patients, whether it’s your intake staff at the ER or if you have a vendor partner or business associate like Aspirion.“
Recent legislative trends have seen some states requiring health insurance to be billed before a lien can be filed. This requirement can significantly affect a hospital’s approach to MVA claims. It’s essential to stay informed about these changes and adjust your processes accordingly.
Enforcing hospital liens through litigation can be an effective strategy, but it comes with its own set of considerations. Hospitals need to weigh the costs of litigation against the potential recovery and consider the optics of pursuing legal action against patients or insurance companies.
Negotiation Strategies and Patient Relations
While hospital liens provide leverage, it’s necessary to approach negotiations reasonably.
“Now, one of our recommendations is to actually build a positive relationship with the personal injury and plaintiff attorneys,” McVey explains. “If they know that you are reasonable to deal with, they’re more likely themselves to not draw hardline stances or go straight to threats of lawsuits, which we’ve seen on multiple occasions.”
This approach can lead to more successful negotiations and better outcomes for all parties involved. When negotiating, it’s important to consider all aspects of the case, including liability limits, other medical expenses, wage loss, and attorney fees.
Drake adds an important perspective on building relationships with attorneys: “And I’ve seen firsthand, law firms that have been routinely filing the lawsuits against hospitals to extinguish the liens are now thankfully reaching out to me directly and we’re getting liens resolved. So, it’s a great tactic to use.”
This underscores the value of open communication and reasonable negotiation in resolving MVA claims.
Staying Compliant and Mitigating Legal Risks
The legal landscape surrounding MVA claims is constantly evolving. Recent trends include the implementation of state-level Patient Protection Acts, which can affect a hospital’s ability to file liens. It’s important to stay informed about these changes and adjust your practices accordingly to avoid potential legal risks.
When faced with legal challenges to liens, hospitals need to be prepared to demonstrate due diligence in their lien filing process. This includes making reasonable efforts to identify all involved parties and following all state-specific requirements for lien perfection.
Leveraging Technology and Expertise
Managing MVA claims effectively often requires specialized knowledge and tools. Many hospitals benefit from partnering with third-party vendors or consultants who specialize in this area. These partners can provide valuable insights into state-specific laws, help navigate complex cases, and offer technology solutions to streamline the process.
Balancing Revenue Recovery and Patient Care
While maximizing revenue recovery is important, it’s equally crucial to consider the patient’s perspective and overall experience. In cases of catastrophic injuries or limited settlement funds, hospitals should consider their charity care policies as a potential option. This approach can help balance the hospital’s financial needs with its mission of patient care.
Effective management of MVA claims in the healthcare revenue cycle requires a multifaceted approach. Hospitals need to stay informed about state-specific laws, leverage appropriate tools like hospital liens, engage in reasonable negotiations, and maintain positive relationships with all stakeholders. By adopting a comprehensive strategy that balances revenue recovery with patient care considerations, hospitals can navigate the complexities of MVA claims successfully, boost revenue, and improve their operating margins.
For more helpful MVA tips, watch Part 1 or Part 2 of our on-demand webinar, “Cracking the Code on Motor Vehicle Accident Claims: Boosting Your Hospital’s Bottom Line.”
Unlock the Full Potential of Your MVA Claims
MVA claims present a complex yet significant opportunity for hospitals to increase their collections. Partnering with an experienced RCM expert isn’t just beneficial—it’s vital for long-term financial success.
Aspirion stands at the forefront of MVA claims management, offering a unique blend of legal expertise, industry experience, and cutting-edge technology. Our specialized team navigates the intricacies of MVA claims with precision, helping ensure you recover every dollar you’re entitled to.
By leveraging our comprehensive approach, you can streamline your RCM processes, maximize reimbursements, free up valuable internal resources, and stay ahead of regulatory changes. We handle the complexities so you can focus on what matters most—patient care.
Ready to supercharge your MVA claims management? Contact us today!
