A major priority of insurance companies centers around holding down or reducing costs associated with automobile no-fault and workers’ compensation claims. In a typical year, this priority is a fairly standard one. However, the current year has seen some major upheaval across nearly all industries due to the COVID-19 pandemic. The insurance industry is no exception. But what will happen looking past the pandemic?
There is no easy answer to this question as of right now. There are, however, steps that insurance companies can consider taking that will assist them in managing the cost of administering workers’ comp and auto no-fault claims going forward.
Nearly every claim contains unique elements and some claims contain much more difficult challenges. These challenges tend to increase in direct relation to the amount and severity of injuries since that can impact the type of services needed to help indemnify each claimant. Those claimants that sustained more severe injuries due to an auto accident will likely need anything from surgery to durable medical equipment (DME) like a wheelchair.
This situation is not only complex but also poses the potential for increased costs. As in the example of an auto accident where a claimant will require a wheelchair, the Healthcare Common Procedure Coding System (HCPCS) comes into play to further complicate the claim. There are thousands of HCPCS codes available and it can quickly become extremely challenging for adjusters to navigate this system and ensure that providers are using the correct codes on all claims.
In fact, many providers will often unbundle codes for a wheelchair. This situation is not ideal for the insurance company since the payout is typically higher with the usage of unbundled HCPCS codes. The higher payouts of course benefit the provider rather than the insurance company, so adjusters must watch out for the practice of unbundling within claims.
Another potential issue for adjusters to watch out for on these types of invoices is the use of not otherwise classified (NOC) codes. As with the practice of unbundling, the use of NOC codes may contribute to the rising costs of claims administration, resulting in unnecessarily higher costs to insurance companies.
The best practice for all claims, whether workers’ comp or auto no-fault, is to identify and reduce the use of unbundling on invoices.The use of NOC codes should be greatly reduced as well, if not eliminated altogether when possible, in order to increase transparency and reduce the chance of your company paying too much for claims.
Working through the complexities of claims, including the use of HCPCS codes, can be time-consuming as well as difficult for adjusters and examiners. This is especially true as the insurance industry looks toward the future and past the current COVID-19 pandemic.
Northwood is a trusted third-party administrator (TPA) of both auto no-fault and workers’ comp claims and will help your company hold down the cost of claims. Schedule a call with Rosanne Brugnoni at 586-755-3830 ext. 3771 to find out how you can help hold down costs post-pandemic.