Workers’ Compensation claims are more important than most providers think. While these claims may represent a smaller portion of total revenue, their impact on patient satisfaction and employer relationships is significant. Managing Workers’ Compensation claims efficiently improves financial outcomes and strengthens ties with key employers who send their employees to healthcare providers. A negative experience can lead to dissatisfaction, impacting both the patient and the employer relationship. It can also negatively affect the patient’s healing process.

The Financial and Operational Importance of Workers’ Compensation Claims

Workers’ Compensation claims are unique in the healthcare financial landscape. Unlike commercial insurance claims, they often require manual processes, complex payer rules, and state-specific compliance. Missteps in these areas can result in delayed payments, higher denial rates, and dissatisfaction.

For healthcare providers, work-related injury claims can account for up to 2% of total revenue but carry high average claim values, often exceeding $4,500 per claim. Mismanaging these claims can lead to lost revenue, with denial rates as high as 15% to 30%. By reducing these denial rates to below 2%, providers can save millions annually.

However, financial impact is only part of the story. The patient experience for this financial class may impact their relationship with the employer who often represents a higher percentage of business to the provider.

The Ripple Effect of Negative Patient Experiences

When injured employees have a negative experience with a healthcare professional or provider—such as receiving unexpected bills, experiencing delays in their treatment plans due to prior authorization issues, or dealing with confusing administrative processes—it reflects poorly on the provider. This dissatisfaction can extend beyond the patient to their employer and to the patient’s healing process.

Employers are key stakeholders in the Workers’ Compensation financial class. They want their workers to receive prompt, high-quality care to facilitate a faster return to work. Most employers may reconsider their partnerships with healthcare providers if employee experience is poor and they report negative experiences. This can result in decreased referrals and lost revenue.

According to UHS’s Midwest Health System case study, improving the claims processes led to:

• Increased collections from $6.9 million to $10.9 million annually
• Reduction in denial rates from 15% to under 2%
• Faster payment times, with the average days to pay decreasing to 37 days

These improvements enhanced financial performance and strengthened relationships with employers by ensuring their employees had better experiences.

Common Pain Points in the Patient Care Journey

1. Delays in Eligibility Verification and Prior Authorizations
   • Patients may experience delays in care due to lengthy eligibility and authorization processes.
2. Billing Errors and Denials
   • Incorrect or incomplete claims submissions can lead to surprise healthcare costs for patients, impacting their outlook.
3. Poor Communication
   • Lack of communication between providers, payers, and employers can leave workers feeling lost and frustrated.

These pain points can significantly impact patient outcomes and the employer’s perception of the provider’s efficiency.

Solutions to Improve Patient Experience

Healthcare teams can take several steps to improve the patient experience and strengthen employer relationships:

1. Proactive Eligibility Verification and Prior Authorization
   • Ensure that eligibility and benefits are verified before the claim is submitted to the payer to avoid delays and denials before they happen.
   • UHS data shows that proactive verification reduces denial rates from 15.15% to 1.88%.
2. Enhanced Communication with Employers
   • Keep employers informed about the status of their employees’ claims to build trust and transparency.
3. Automating Claims Management
   • Utilize technology to streamline claims submission, reduce manual errors, and increase first-pass rates. UHS has achieved a first-pass rate of over 95% with automated processes.
4. Implementing a Center of Excellence for Claims
   • Establish dedicated teams that focus on complex claims to improve efficiency and patient satisfaction.

The Role of Specialized RCM Partners in Workers’ Compensation Claims

Many healthcare providers struggle with Workers’ Compensation claims because traditional RCM vendors lack the specialized knowledge and processes required to handle them efficiently. Partnering with a specialized RCM partner like Unified Health Services (UHS) can help providers:

• Improve cash flow
• Reduce administrative burdens
• Strengthen employer relationships

The UHS Workers’ Compensation White Paper highlights that engaging a specialty RCM partner can reduce denial rates to below 2% and save providers millions in lost revenue. This partnership also ensures compliance with state-specific regulations and improves overall client well-being and employer satisfaction.

Conclusion

A negative patient experience can have far-reaching consequences beyond the immediate financial impact and total cost. It can damage employer relationships, reduce referrals, and ultimately hurt the provider’s bottom line. By focusing on improving the patient journey through proactive processes, enhanced communication, and specialized RCM partnerships, healthcare providers can enhance financial outcomes, employer loyalty, and improved patient outcomes.

Providers that prioritize claims management can position themselves as trusted partners to employers, ensuring long-term success in an increasingly complex healthcare landscape.

Want to learn how the Unified Health Services team can help your business optimize workers’ compensation claims management and improve employer relationships? 

Request a Free Claims Assessment Today!