7 Potential Pitfalls Hospitals Can Make When Choosing a Complex Claims Vendor
Choosing a complex claims partner is an important decision for any healthcare system. Being knowledgeable of these seven potential mistakes when choosing a complex claims partner can ease any CFO’s mind and give the health organization more financial stability with less headaches.
1.) Hiring a Complex Claims Vendor who doesn’t have licensed attorneys reviewing accounts.
By law and oath, an attorney has an ethical obligation to represent a client’s best interest. This responsibility removes potential conflict of interest worries and ensures that the vendors’ s guidance is more reliable. If your current/potential vendor doesn’t have an attorney led business model, it is time to find a complex claims partner that has your best interest in mind.
2.) Hiring the friendly nicest vendor that you meet.
Due to the ease, the temptation to hire the first vendor you see at a trade show or that comes by your office with gifts and showmanship is tempting but often is not the best choice. Your healthcare system deserves more consideration on finding the right fit. Take time to meet and question several complex claims vendors before picking the best match for your health system.
3.) Picking a vendor with the wrong or without specialty.
Some vendors just happen to do complex claims as a side line of business and are not experts in the field. Be sure to recognize a vendor’s strengths and weaknesses before signing a contract. If you are looking for a jack of all claims then you will find the master of none. Always ask if they subcontract or outsource any of their business.
4.) Picking a vendor with an unharmonious approach and one size fits all system.
Your hospital system may have different goals that do not align with some vendors. When selecting a right vendor, find out their approach and ask them if their reports or work flow is customizable to fit your needs. If you find your vendor giving you an unacceptable answer, you need to find a different complex claims partner.
5.) Not asking for previous results or qualifications.
To be a trusted complex claims vendor, the company must produce visible results. Always ask the potential/current vendor about their previous results for other similar clients and the qualifications of their staff. Results must be proven and analyzed to ensure that you are getting most out of this relationship. It should be a friction-less boost to your business office.
6.) Not understanding how they are paid.
Some vendors charge not only a commission, but they will also charge you a flat rate regardless of results. Others charge a very low percentage to only work the “low hanging fruit” accounts but leave the cherry picked extremely complex accounts to work by the hospital staff. Some vendors are paid commissions by billing health insurance, a serious conflict of interest. If the potential vendor earns more by disregarding your hospital system’s best interests, refuse to partner with them.
7.) Not appreciating to whom the vendor answers.
With the influx of private equity firms and mergers in acquisitions, knowing to whom the vendor answers is vitally important. Is it to the vendor’s shareholders or owners? Complex claims vendors should only answer to clients and not to investors.
By Ronald Morris, Senior Supervising Attorney with RevClaims
The attorney-lead RevClaims team works with all aspects of insurance identification, timely updates, and reduction requests. RevClaims’ unparalleled technology gives the feeling that it is an extension of the hospital business office that successfully recovers an often-lost source of revenue for services rendered.