Rising Costs In The Insurance Industry: What Can Be Done

With a new year comes additional challenges for insurance companies administering both workers’ compensation and automobile no-fault claims. Continually rising costs for prescription medications as well as durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS) bring ever-present challenges and obstacles for insurance companies to work around. While there are several factors that figure into the increasing costs, the most important thing for insurance companies to focus on involves ways to mitigate the cost challenges within their control.

As an experienced third-party administrator (TPA) of auto no-fault and workers’ compensation claims, we at Northwood recognize these challenges and have compiled four ways that will assist insurance companies in addressing this problematic topic. 

The first and most efficient way to combat the ever-rising costs in the industry is to partner with a TPA. Each claim administered by your insurance company will benefit from the thorough and objective review provided by the TPA. Innovative procedures developed through years of experience translate to savings for insurance companies. 

Secondly, insurance companies will reap significant cost savings within claims administration by gaining access to discounted rates on DMEPOS services and prescription medications. Building a network of providers that agree to lower rates does take an enormous amount of time and effort. Fortunately, a TPA with its own network of trusted providers will offer access to this network to your insurance company as well as your claimants. 

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A third method to battle rising costs involves implementing a pre-authorization process on each and every claim. The frequency of overpayments and payment of non-injury-related services will be greatly reduced by pre-authorizing every medication and treatment for each claimant. Claimants will still have access to the appropriate care they need yet insurance companies will avoid paying for treatments and medications that do not fall within the scope of the claim. 

Finally, bundling of Healthcare Common Procedure Codes (HCPCS) during the pre-authorization process is essential to saving money for your insurance company. Many providers unbundle components of DMEPOS services in an attempt to receive a larger payment from the insurance company. Northwood’s process of rebundling procedure codes reduces costs for your company. 

It is more important than ever for insurance companies to control costs. Partnering with a TPA, accessing a trusted provider network with discounted rates, implementing pre-authorization and bundling HCPCS codes are all essential to saving your company claims dollars. Northwood will bring its decades of experience to your company and save you time and frustration in the process. Please call Rosanne Brugnoni at 586-755-3830 ext. 3771 to discover additional solutions that are customized to your needs.

Clarity In Billing Improves The Bottom Line

A seemingly endless variety of factors contribute to increased claims administration costs. Whether your insurance company administers automobile no-fault claims or workers’ compensation claims, it is essential to always take a proactive approach to controlling the cost of claims. An important topic to address within your company concerns the matter of clarity, or lack thereof, in billing. Overall, achieving clarity and transparency in billing can improve the bottom line. 

A major opportunity to achieve greater clarity in billing pertains to building a trusted network of providers. It is vital to both the bottom line and to claimant satisfaction to provide access to high-quality medical providers. This can be a very time-consuming avenue and can also be very difficult to achieve, so insurance companies will save both time and money by partnering with an experienced third-party administrator (TPA) that has already taken the initiative to build a credentialed network of providers. Furthermore, the network of providers should be expansive enough to serve claimants all over the United States and also provide discounted rates to both the insurance company and its claimants. 

These providers that are in the TPA’s network and that agree to give the insurance company discounted rates should also offer access to prescription medicines at no out-of-pocket cost to claimants. Claimants who are given the opportunity to obtain their injury-related prescriptions without the need to pay up front or submit reimbursement requests to their insurance company tend to report much higher satisfaction levels with the claim and with the insurance company itself. Therefore, the elimination of out-of-pocket claimant costs contributes to increased clarity in billing that further impacts the bottom line. 

Insurance companies can also look to the Healthcare Common Procedure Coding System (HCPCS) for an opportunity to achieve more clarity in billing. The HCPCS procedure codes are notoriously complex and inherently provide the potential for overpayments to providers. Additionally, some providers may use not otherwise classified (NOC) codes frequently in an attempt to request higher payments from the claimant’s insurance company. Access to an experienced TPA that has the knowledge and resources to review and bundle these codes together where appropriate can significantly increase clarity in billing and reduce costs to the insurance company. 

At Northwood, we are committed to providing excellence to the insurance companies that partner with us. We offer a trusted provider network, discounted rates, the elimination of out-of-pocket claimant costs and our extensive experience with HCPCS procedure codes and bundling.

For a more customized look at the ways Northwood can help you achieve more clarity in billing and improve the bottom line, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 to schedule a meeting.