Outsourcing of Complex Claims on the Upswing

An increasing number of hospitals are turning to outsourced providers of complex claims management to help manage their hardest to collect dollars. The number of complex claims outsourced to specialists reached 39.8% in the 3rd quarter of 2016 – up from 20.4% in 2014. These complex claims typically take up an outsized portion of in-house staff time even though they typically don’t result in a large windfall for the hospital. That’s why this process is ripe for outsourcing.

This article found at Healthcare Finance by Susan Morse explains the nature of complex claims and why outsourcing of them is on the rise.

“Complex claims – those typically involving motor vehicle, workers’ compensation, injury, catastrophe and general liability cases – present a mixture of challenges for a hospital’s billing and collections staff, who are usually not experienced in dealing with non-traditional payers, according to Black Book.

“These claims also tend to be marginalized because they account for a relatively small amount of total hospital reimbursement and this results in complex claims written off when it’s decided limited hospital manpower is better spent managing traditional claims,” [Doug] Brown [managing partner of Black Book] said. “In fact, when compared to traditional claims, complex claims were written off at a significantly higher rate last year.”

As a result, the complex claims outsourcing market is expected to grow at least 18 percent annually through 2019, adding to nearly 76 percent of U.S. hospitals already outsourcing some extended business office tasks.”

Read the entire article here: More hospitals outsourcing complex claims to collect revenue, survey finds

Whether collected in-house or outsourced to a specialist, complex claims pose a challenge for hospitals. Hospitals must be prepared for these challenges by making sure their electronic documentation is meeting the highest standards. Especially when outsourcing to a 3rd party, hospitals must ensure their documentation is complete, accurate and easy to understand. Otherwise even the best specialist will be unsuccessful trying to claim this revenue.