Continuing Impact of Auto No-Fault Insurance Reform
In 2019, Michigan began moving toward automobile no-fault coverage reform. This reform impacted policy holders in the entire state and enacted significant changes to auto insurance coverage. The reform continues to impact individuals as well as insurance companies, especially those administering auto no-fault claims.
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Before the reform was enacted, Michigan required licensed drivers to hold unlimited medical benefits under their auto no-fault coverage. Post-reform, insured drivers in Michigan now have limits on their medical benefits coverage under their auto policy. Clearly, this reform impacts both coverage and premiums. When it comes to insurance companies administering auto no-fault claims, it is critical to stay updated on the reform’s impacts. It is also vital that your insurance company takes a proactive approach to cost containment for its auto no-fault claims.
The most efficient way to manage both of these important priorities is to partner with a durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS), pharmacy and ancillary service provider. One advantage to this type of partnership pertains to fee schedules, since some providers offer fee schedules that are lower than the reform’s fee schedule, which is based on Medicare.
Another factor to consider when partnering with a provider is whether the provider employs utilization management (UM) reviews. These UM reviews involve an evaluation of every medical provider invoice. The reviews are designed to ensure each physician prescribed service is directly related to the claimant’s injuries, and to ensure the physician prescribed service is safe and appropriate for the claimant.
Furthermore, a UM review also analyzes provider invoices for appropriate usage of the Healthcare Common Procedure Coding System (HCPCS). A thorough UM review will flag inaccurate HCPCS codes that may have been recorded in error. It will also flag attempts at unbundling. Some providers intentionally unbundle HCPCS procedure codes in an attempt to invoice insurance companies for an artificially inflated amount. If you are not currently reviewing invoices for the appropriate usage of HCPCS procedure codes, you may be paying unnecessarily high costs for physician prescribed services. Implementing UM reviews can reduce those unnecessary costs, which can significantly impact your bottom line over time.
Northwood is a trusted DMEPOS, pharmacy and ancillary service provider with over 30 years of experience administering automobile no-fault claims for insurance companies. Since the auto no-fault reform occurred in Michigan, Northwood has stayed on top of updates and impacts of the reform on insurance companies. In its three decades of experience, Northwood has also refined multiple processes and procedures that help insurance companies with cost containment, claimant satisfaction, and more, both before and after no-fault reform.
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Please call Rosanne Brugnoni at 586-755-3830 ext. 3771 to discuss Michigan’s auto no-fault reform, its impact on your company, and the ways your company can benefit from Northwood’s experience.