An analysis of 10,000 returned workers’ compensation invoices that were submitted through Acrometis’ CLAIMExpert® platform highlighted costly inefficiencies in the relationship between care providers submitting workers’ compensation bills and the payers responsible for determining their compensability. The Acrometis’ Strength in Numbers report reveals the startling fact that most (81 percent) of those returned bills are never resubmitted for payment.
The 10,000 bills analyzed were rejected by CLAIMExpert before ever reaching the adjusters’ desks. The mere fact that 81 percent of these were never resubmitted shows the need for identifying and eliminating erroneous bills early in the claims process, long before companies have expended resources and incurred unnecessary costs reviewing and addressing them. The Acrometis report cites the reasons for rejecting these bills, including duplicate submissions, incomplete treatment notes and missing Current Procedural Terminology (CPT) codes and National Drug Codes (NDC).
”This analysis underscores the need for payers to be vigilant very early in the process,” said Acrometis CEO P. Kevin Kilroy. “Reducing adjuster workloads by 20 percent or more by returning questionable invoices and auto-adjudicating others will free claims managers to focus on more productive activities.”
Kilroy noted that the workers’ compensation industry is being challenged by escalating medical expenses, regulatory challenges and a fundamental tectonic shift with the expansion of ICD (International Classification of Diseases) codes now scheduled for October of 2014. “Payers are doubly challenged because ineligible invoice submissions will inevitably increase, resulting in significant revenue leakage. Clearly, identifying and returning ineligible submissions at the onset of the claims process is a must-have capability,” he said.