Malvern, PA – To process numerous claims as quickly as possible, many workers’ compensation payers automatically approve provider bills that are under a certain dollar amount. This practice costs payers millions, according to a new Strength in Numbers report from Acrometis.
As cited in Acrometis’ first Strength in Numbers report, 81 percent of provider bills, which are returned because they are ineligible or incomplete, are never resubmitted. Auto-approving all submissions under $250 results in overpaying by $8 million when considering only the submissions that were returned and not resubmitted. That overpayment soars to $133 million when including all 200,000 submissions in that analysis.
“Establishing a dollar-value threshold for auto-adjudication sets you up for overpayment and possibly accepting unnecessary treatments,” said Acrometis President/COO Jerry D. Poole, explaining that auto-approval carries a risk for agreeing to treatment that exposes payers to greater costs.
In some jurisdictions, agreeing to pay for even a prescription can result in the payer accepting all responsibility for the claim. Also billing documents contain information that could be overlooked by not examining a small bill. For example, in the state of New York, approving payment for an office visit also means accepting the doctor’s proposed treatment, such as an MRI.
“All bills, regardless of dollar amounts need to be reviewed for appropriateness and relatedness, and it isn’t practical for adjusters to do this manually,” Poole said. “This is where automated claims processing systems come in; clients using our system can auto-adjudicate up to 75 percent of the bills, while still ensuring their appropriateness and relatedness to the claim.”
A copy of the report is available here: Acrometis Strength In Numbers Report: Auto Adjudication
Source: Acrometis/King Knight