October 18, 2022

Strategies for Managing Third-Party Liability Claims

Successfully tracking down Charity accounts that qualify for reimbursements can be hard, plus navigating third-party liability claim recovery can be challenging for providers. This post discusses some practical and efficient suggestions that your hospital can implement to manage your third-party liability claims recovery efficiently.

When your hospital provides Charity, chances are, you are never aware that many of your patients have received reimbursements from third-party liability insurers. This means that you have lots of money lying somewhere you never even knew existed. You are not alone. 

The truth is, many providers and hospitals provide Charity care, but the benefiting patients often get TPL reimbursements without paying anything back to the hospitals. The second problem that most hospitals face when it comes to TPL claims recovery is that they use a manual recovery method to trace Charity accounts – a process that is often subject to delays due to legal proceedings.

On the bright side, including an efficient TPL claims recovery technique in your revenue cycle management can raise your accounts receivable (A/R) by additional hundreds of thousands and maybe millions annually. But how can hospitals and providers improve Third-Party Liability reimbursements to recoup as much as 100 percent of the charges levied for the care provided? In this post, we discussed some practical and efficient suggestions that you can implement to manage your third-party liability claims recovery efficiently.

Understanding TPL’s Complexities

To begin with, healthcare organizations need to understand which categories of emergency care are covered by TPL. Typically, TPL insurers are responsible for injuries caused by the vehicle, property, or product owned by the insured party. In no-fault states, which are Florida, Hawaii, Kentucky, Massachusetts, Michigan, New Jersey, Pennsylvania, Utah, North Dakota, Minnesota, and New York, the insurer still has to bear the responsibility for the damage caused regardless of whether the third-party (victim) or insured (property owner) is at fault. 

This means that TPL includes workers’ compensation, which covers on-the-job injuries. This is a bit easy to navigate because workers’ compensation exists in every state and covers almost every worker. TPL also includes Motor vehicle accidents (MVA) and general liability claims, such as slips and falls or any other claim where someone other than the patient is responsible for the cost of medical care. 

However, not every patient has TPL coverage and many of those who are insured are facing increasing copayments. These are some intricacies that make third-party liabilities difficult for providers, warranting the need to outsource TPL handling to experienced companies. When it's time to collect TPL, not knowing these may lead to lots of money slipping out of your hands.

Track Down Liability to Responsible Parties’ Insurance

Even though some patients may not have an insurer on record at the time of treatment, it is very common for many patients to receive reimbursement later. So how do you know when a charity account qualifies for a successful claims recovery? Besides this, you want to also keep in mind that the parties responsible for the payment of claims differ in different circumstances and complications may also arise when patients have policies written in no-fault states (these are states where the insurer must pay the policyholder’s claim regardless of who is at fault). 

Essentially, providers must be able to identify charity accounts that have received compensation and track down liability to responsible parties’ insurance to successfully collect on third-party liability claims. If your hospital’s RCM team does not know how to navigate this, you’ll likely end up losing money when you attend to a patient wheeled into your facility by first responders. Healthcare providers also need to understand related compliance issues for the state where the at-fault party’s auto insurance or workers’ comp policies were written.

Partnering With an Experienced TPL Recovery Firm

Providers need to create a game plan for effectively managing their TPL claims. This allows you to have professional eyes on all accounts that qualify for TPL recovery while your team focuses on your core competencies (including in-patient and outpatient collections). The best way to achieve this is to outsource your TPL claims recovery to a professional TPL partner. This produces quicker results than having to train or hire team members to handle it.

Actually, building internal expertise in TPL to manage the changing regulations and staff training is a good idea, but that can be a full-time job that may cost you more money. Allowing a partner to work on all your TPL-related collections gives your revenue cycle management team the ability to scale your business and increase your A/R using a cost-effective approach.

But that’s not all. You also get to avoid the hassles that come with navigating the compliance complexities of TPL claims. You need to understand the complexities of conditional billing health insurance in auto-accident-related claims as well as complying with the Centers for Medicare & Medicaid Services and Medicare Secondary Payer regulations. The Affordable Care Act also prohibits providers from contacting the patient when attempting to recover on Charity. In some cases, you also have to understand relevant state regulations. 

Leverage Technology to Facilitate TPL Payments

As against chasing down TPL recoveries manually, your TPL partner must also have technology that can identify expected payments and make recovery faster. You don’t want to spend resources chasing down insurance claims that do not yield expected results. This is why our TPL Claims Recovery tool at Discover Claims makes all the difference.

Discover Claims' technology is the main differentiator when it comes to tracing Charity accounts that were written off but have Third-Party Liability coverage. This tool uses artificial intelligence, making it extremely easy to automate a hospital's auditing process. When a hospital sends us hundreds of thousands of accounts, we can literally tell which patients now have pending legal actions in the insurance or courthouse system within about 3 days. It’s that easy now – with all the hassles gone!

While the overall contribution of TPL payments for car accidents or workers’ compensation claims may represent a small portion of your hospital's accounts receivables, stopping the leakage can boost your financial standing significantly. 

About Discover Claims

Discover Claims is a tech-enabled RCM service provider focused on auditing hospitals' Charity accounts to identify those that now have insurers on file. Our solution is targeted at helping hospitals that are losing millions of dollars every year by giving free care to patients whose care has been written off but later gets paid by Third-Party Liability insurers. 

To keep this from going unchecked, Discover Claims developed an automated claim matching tool that finds those legal actions and ensures the hospital always gets its fair share of reimbursement. If you fear that some of your patients may have received free care and a settlement check, find out now and get reimbursement for your services. For any questions, contact billy.ayoola@discover-claims.com.‍

This content is powered by Mission.