Insurance carriers administering automobile no-fault and workers’ compensation claims that encompass claimant use of durable medical equipment, prosthetics and orthotics services (DMEPOS) find themselves facing several challenges, especially in regard to claims involving multiple services and treatments.
The Healthcare Common Procedure Coding System (HCPCS) is utilized by providers to code services and equipment used in claimant treatment regimens and request payment from insurance companies. The complex nature of HCPCS represents the potential for rising claims administration costs and overpayments to providers due to the common practice of unbundling services. Fortunately, a third-party administrator (TPA) such as Northwood is able to assist in minimizing costs and challenges. The following are three commonly seen challenges with unbundling along with efficient solutions that help mitigate them.
One such challenge pertains to providers unbundling services since HCPCS procedure codes are available for individual components. The process of unbundling increases the number of claim lines and unnecessarily increases costs for insurance companies. Bundling services will have the opposite effect and assist insurance companies in reducing costs.
Secondly, providers that unbundle services and utilize more claim lines also typically generate additional paperwork for adjusters and examiners. In contrast, the process of bundling actually significantly reduces the paperwork for insurance companies. This, in turn, allows adjusters and examiners to more efficiently administer claims which contribute to a reduction in claims administration costs.
Finally, the use of not otherwise classified (NOC) codes drives up the cost of claims for insurance companies. With the thousands of HCPCS codes available there is almost always an accurate code to use for each and every procedure. The use of NOC codes represents an opportunity for insurance companies to greatly minimize them by partnering with a third-party administrator.
While these three challenges are significant, working with an experienced TPA can mitigate these issues. Northwood has partnered with insurance companies for more than 20 years to proactively manage claims. We execute a pre-authorization process to reduce the utilization of not otherwise classified (NOC) codes, increase transparency and reduce unbundling. Insurance companies can confidently partner with Northwood as their DBM to assist with reducing claims costs due to unbundling. For additional information, please schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.Leave a reply →