Employer health plans are evolving the way they think about and manage health plan subrogation. Specifically, plans are viewing subrogation as a more essential part of their overall healthcare cost containment strategies.
However, placing renewed emphasis on subrogation is just the first step in increasing recoveries.
To see meaningful improvement, benefits and claims professionals must account for internal and external factors that result in overlooked opportunities to recover medical payments through subrogation.
Here are five of the biggest reasons subrogation opportunities are missed:
1. Inaccurate coding at the point of care
More than 50 percent of motor vehicle accidents, which make up most subrogation cases, are not correctly coded as MVA ICD by healthcare providers. This initial inaccuracy makes it difficult for health plans to identify potential subrogation opportunities from the outset.
2. Ineffective questionnaire process
The traditional method of using subrogation questionnaires to gather information from members is highly inefficient. Only about 15 percent of these questionnaires are ever completed, and of those, only four percent lead to recoveries. This low response rate significantly limits the ability to identify and pursue subrogation cases.
3. Reliance on manual processes and human knowledge
The standard subrogation process heavily depends on human eyes and attention to identify and assess third-party liability. This manual approach is prone to errors and oversights, especially when claims processors or analysts lack the necessary knowledge or experience to accurately evaluate claims.
4. Delayed information gathering
The time it takes to collect all the necessary details for a claim can stretch into weeks or months. This delay can result in missed opportunities for subrogation, as crucial information may be lost or become more difficult to obtain over time. This delay can also result in missed deadlines, subsequently hindering or even negating subrogation opportunities.
5. Lack of technological integration
Many health plans have not yet fully embraced technological solutions that can automate the identification and assessment of third-party liability. Without leveraging advanced data aggregation and analysis tools, health plans miss out on the potential to quickly and accurately identify subrogation opportunities.
Identifying and subrogating complex claims is tedious, burdensome and costly for employer health plans. To better ensure maximum recoveries, benefits and claims professionals can turn to outside help. With the emergence of healthcare technology companies, subrogation has never been easier and more cost effective. Learn more about how this technology can lead to a higher success rate in subrogated claims.
Brittney Patterson is the VP of Business Strategy and Operations of Intellivo, steering the strategic and operational alignment across all services within the organization to maximize the value achieved for clients.
Interested in more? Check out our just published eBook “Subrogation for Health Plans: 5 Things to Know.”