Managed correctly, auto-related accident claims yield higher reimbursement rates than most other financial classes. When under-managed, accident claims can expose a hospital to costly compliance risks, lost potential revenue and patient dissatisfaction. Below is a list of KPI’s that should be used to track and manage auto accident claim performance:
ACCIDENT CLAIM KPIs
Total Number of Auto Accident Claims – The number of auto claims varies by trauma level and hospital size. The goal is to identify 100% of accounts related to auto accidents, and then treat them as a separate financial class
Auto Accident Gross Charges – Accident claims typically represent 1%-2.5% of Gross Patient Revenue
Auto Accident Claim Insurance Leads – In PIP states, leads (i.e. potential payment sources other than health insurance) should be identified for 60%-70% of patients involved in an auto accident. In non-PIP states, leads should be identified for 25%-35% of these patients
Reimbursement from “Non-Health Insurance” Payers – Liability and No-Fault recoveries typically represent >50% of all payment dollars in most states
Reimbursement Rate by Attorney – Best practice hospitals track reimbursement rates for each plaintiff attorney. With visibility, the hospital can negotiate with below-market attorneys from a position of strength
Average Age of Resolved Accounts (Excluding Liability) – In most states, the average age of non-litigated auto claims should be approximately 90 days
Average Age of Resolved Auto-Related Liability Accounts – In most states, the average age of litigated auto claims is typically 11-13 months.
While accident claims are extremely complex, employing best practices and tracking performance enables providers to be fully paid for these valuable claims.