Hiring the Right TPL Vendor: What to Consider
By Cassie Henson, Executive Vice President of Third Party Liability, Elevate Patient Financial Solutions®
The summer season has officially begun. More people are on the road, boating and riding all-terrain vehicles, and with this increase in outdoor activity, accidents and injuries occur. During the summer months, motor vehicle deaths are at their highest, according to the National Safety Council.1 As health systems and healthcare providers see an influx of third-party liability (TPL) claims that are difficult to identify and time-consuming to navigate, most do not have access to a team of in-house staff with the specialized expertise and technology needed to resolve TPL claims. Additionally, according to the Healthcare Financial Management Association and Eliciting Insights latest report, hospital leadership surveyed consider these complex claims a top pain point in the revenue cycle.2 Consider the following when outsourcing to a best-in-class TPL vendor:
Market-leading TPL Expertise
The best TPL teams support clients and their patients to ensure all available payers who could be responsible are identified and timely billed, while maintaining compliance with local and federal regulations. This service helps reduce a healthcare provider’s A/R days and increase the collectability on this set of accounts that may often go unpaid, especially for self-pay patients. In turn, this allows patients to satisfy their medical bills. Trained experts skilled at educating patients are needed because patients often do not understand the accident claims process. They may not know what coverage they have available, and too often have been seriously injured or grieving a lost loved one.
Having the Right Process
TPL is often a complicated discovery process of putting together a puzzle and ensuring all the pieces fit. There is no one set model to follow. There are multiple questions to ask and analyze to ensure accounts are progressing as they should while navigating the diverse statutes and case laws that apply. Showing compassion and concern and pushing through the difficulty of questioning insurance adjusters and attorneys who are not always happy to share information is key. Taking the time to listen and ensure each account is not just another number but involves a person who needs help resolving their claim and accounts is also important. This ensures hospitals are reimbursed for services and patients do not face medical debt.
Using AI-powered Technology
There are many exciting innovations in TPL and one of these is the use of artificial intelligence. One of the greatest challenges for TPL is patient cooperation. Having a strong discovery process including data mining, more patient-friendly contact with automated online platforms, as well as predictive modeling to assess the viability of accounts is essential. This enables claims involving a third-party payer to be quickly identified to minimize missed opportunities, maximize reimbursement, and automate decision-making processes for faster recovery.
Hiring the right TPL vendor that has the expert staff of attorneys and healthcare RCM professionals and innovative technology to identify and collect on all potential payer sources in compliance with governmental regulations is critical. You will want a vendor that coordinates with the provider’s billing office and includes electronic billing and electronic settlement management to expedite claim resolution. Since many patients who are involved in an auto accident or other TPL-related event are not aware that financial help is available, a trusted partner is able to help patients find a source of payment to alleviate the burden of medical bills and improve their patient experience.
About Elevate Patient Financial Solutions®
Elevate Patient Financial Solutions® is a trusted partner that delivers superior RCM solutions to hospitals, health systems, and healthcare providers nationwide. For more than 40 years, we have been developing and continually refining our best-in-class services and innovative, specialized technology to address the most complex challenges of the revenue cycle.
We have carefully built teams with unmatched industry experience and service-specific expertise, and our commitment is to deliver on our promises, seek continuous improvement and the pursuit of excellence to deliver elevated results for our clients. Our services include Eligibility & Disability Enrollment, Self-Pay, Third Party Liability, Workers’ Compensation, Veterans Administration, COB Denials, Out-of-State Eligibility, and A/R Services, including High and Low Balance A/R projects, Zero Balance Payment Recovery, Legacy Receivables and Extended Business Office engagements.