Once you have identified which subrogation cases have recovery potential and which do not, it’s time to make sure you are optimizing program performance in three key areas:
- Platform – leveraging technology and automation to improve results
- Process – evaluating recovery workflows to ensure efficiency is maximized by leveraging available technology
- People – recruiting and maintaining a united and coordinated team of people
Optimizing your platform
Leveraging the most current technology and automated systems will yield more recoveries with less cost and fewer resources.
Cloud technology offers a next-generation solution for loading and processing claims data, with cloud-based data storage and on-demand added capacity. Not only is cloud storage scalable and much less expensive than physical data storage, it allows for easy and mass loading of claims data and execution of claims processing. Given the ability to load multiple data files at the same time, health plans can quickly pursue reimbursement, a crucial part of maximizing recoveries. In addition, cloud-based storage providers offer encrypted HIPAA compliant instances in compliance with the Security Rule.
Case management software
Powerful, flexible case management software solutions are critical to improving your subrogation process. Subrogation processes involve large amounts of mail, including questionnaires, letters, and other correspondence between multiple parties. It is important to have the right software to track and manage your cases.
One component of an effective case management software solution includes integration of two-dimensional bar codes on all correspondence. Investigation questionnaires are typically the first step in a subrogation investigation. If those questionnaires and follow-up letters are bar-coded, they can be tracked more effectively. Bar codes also reduce the risk of a HIPAA breach by preventing questionnaires from being associated with the wrong case.
Other examples include: introduction of a library of template-based letters that can be selected and generated systematically; integration of fax functionality that allows the user to fax letters directly from the application; creation of time stamped activity description that records every activity undertaken on a case; and integration of plan language within the application so the user can access the applicable plan information on a case by case basis.
Optimizing your process
An automated workflow that is proactive, predictive, and intuitive is the foundation of next-generation subrogation solutions. It is important that both your case management tools and workflow have the flexibility to adjust to changing conditions and process improvements.
Ideally, an automated process will trigger a “next” event whenever an event occurs, i.e., if a notice of lien or reimbursement rights is sent, the system should automatically schedule an event to follow up on that notice. Today’s best automated systems remove the need for manual scheduling. This frees up your employees and resources to focus on more meaningful tasks in the process.
Taking a broad look at what’s working—and what’s not working—can help to streamline your process. You may find that the traditional first step of sending a questionnaire isn’t the most effective for your investigation. Some populations are slow to respond to mailings and they often go unanswered. Bypassing the questionnaire and initiating your investigation with an automated ISO query may be a better option.
It is also important to look at the cost-effectiveness of an ISO query vs. a more traditional mailing. User interface tools, like the one used by Discovery Health Partners, let you manage the selection and cost of ISO queries. An automated and user-selectable dashboard sorts information by various claim categories or by the age of the case. Analytics and data tracking tools give you a full picture of cases that are a “hit” or “miss” with the query. A close examination of this data lets you determine the overall effectiveness of your ISO automation.
Proactivity is a must in all phases of the subrogation process. When members don’t respond to mailings, outbound calling becomes a critical step in obtaining information. Leveraging all possible investigative tools like court documents, police reports, and ambulance run reports can help identify cases that have recovery potential. Legal oversight and attorney involvement should be present from the start of an investigation to provide ongoing communication and counsel on any changes in laws.
Optimizing your people
Technology isn’t enough when it comes to optimizing your recovery process. You need the right people to interpret and synthesize your data. In short, your people need to be able to recognize a viable subrogation case when it is in front of them. This analytical outlook coupled with a high level of comfort on the phone and a soft touch with people is a good mix for a subrogation investigator. They will know the right questions to ask, have the skill to analyze the data, and possess the initiative to follow up on those compelling cases.
Identifying the right candidates is just the first step. Training, continuing education, and workplace incentives are crucial to maintaining your team. Workplace incentives can go a long way toward boosting morale for a united, coordinated staff who will contribute to the success of your plan.
Rising health care costs are a concern to us all. Successful subrogation can help contain those costs, but the entire process—from the platform to the people—needs to be optimized so that resources are used wisely and effectively. A highly optimized subrogation process results in better tracking of metrics and data, and an uptick in recovered losses. For more on metrics and measurement, read Part III of our “Next-generation subrogation solutions” series.