Frustration with auto injury claims is common among many medical facilities as well as the billing companies that support them, but 360 Medical Billing Solutions, a specialist in urgent care and emergency room medical billing, is here to help. While auto claims can be a bit more complex, the upside is auto carriers tend to be much more efficient and fairer at paying claims than their health insurance counterparts!
There are potentially two payers when it comes to auto collisions and urgent care & /or emergency room medical billing claims:
1. First party payers (PIP/Med-pay claims)
This is your patient’s carrier. This no-fault coverage provides immediate payment for medical bills. There is no need for a liability investigation or settlement negotiations. This coverage will have a limit, though, and when it’s gone, it’s gone. This is why streamlining the claims submission process is crucial to getting your patients’ bills paid.
2. Third party payers (Liability claims)
This is the carrier for an “at fault driver.” If you’ve ever been frustrated with the length of time it took an auto carrier to pay, then it was likely a 3rd party claim. These require a liability investigation to determine fault, and can involve settlement negotiations even after the bills have been reviewed.
Though these claims often take longer (especially if an attorney gets involved), there is hope! They will still pay fairly as the PIP/Med-pay claims do, and there is a much longer statute of limitations for settlement than what you see with health insurance claims.
How do urgent care and emergency room providers streamline the medical billing process?
- Ask for auto insurance information as well as health insurance. This makes the information readily available to you or your billing rep when and if the patient does choose to file with auto insurance. If possible, clarify if the auto insurance is 1st or 3rd party (or take both, if they have it).
- The patient needs to be aware that auto claims often require a higher level of cooperation than health insurance claims.
- 1st party claims are simpler, but the patient will still need to make the claim and provide accident details. Your billing rep can’t do that for them.
- Before a 3rd party pays, they will need to determine if their driver is at fault (the liability investigation). Without the patient’s cooperation, that carrier could deny entirely.
- Whether 1st or 3rd party, the patient is required to provide a signed medical authorization. The auto carrier will provide this form on their end. Without this signed form, no medical records can be sent. No medical records = no payment.
- Make sure you are sending your claim to the right place. Most auto carriers have centralized customer service and document centers. Insurance agents are not adjusters and do not work injury claims, so make sure the address is not just your patient’s agent. A simple hint is that the claims address will almost always be a PO Box. If you have a physical address, it’s probably wrong.
- Obtain the adjuster contact info and a claim number. The patient will get this information when they call in the claim. It’s much more efficient to talk directly to the adjuster than calling a generic 800 number.
How can 360 Medical Billing Solutions help?
- We facilitate between our clients and carriers to assure that claims are accurate, submitted to the correct entity, and ensure the adjusters have everything they need.
- We communicate directly with both facility and patient regarding questions about the process.
- We follow up on claims once submitted, correct any issues and assure timely payment.
- We negotiate a fair settlement based on what is usual and customary.
Some final thoughts:
- Your patient has the right to refuse to file with auto insurance. There are many reasons patients may make this decision, but in the end, it’s their own choice.
- Keep the above in mind when making a decision on “self pay” discounts and adjustments. A patient in an auto accident may opt for self-pay while still making a claim with an auto carrier. In these cases, patients could very well be pocketing the full amount of your billing despite your discount.
- These tips also apply to any kind of “3rd party liability” claim—not just auto accidents. Be careful, though, that commercial liability claims are not being filed as work comp. Many facility or billing reps may see the name of a business and think it’s work related when it isn’t.
Hopefully, these tips will help reduce your frustrations regarding emergency room billing reimbursement for auto injury claims. We are here to help if you need assistance!
Article by James Beard, 360 Medical Billing Solutions Client Representative