March 25, 2011 was the 100th anniversary of the Triangle Shirtwaist Factory fire in New York City, a devastating fire that fatally injured 146 workers, mostly women between the ages of 13-23. Most died attempting to escape the flames, jumping from nine and 10 stories up, due to the employer’s complete disregard for safety measures as basic as fire escapes and clear exits. The public outrage at this event, and the memorials and tributes to the Triangle victims that continue today, signaled a turning point in the fight for safer workplaces, workers’ compensation and the rights of workers’ in America.

As background to this event, prior to mid-1911, there were no workers compensation benefits as we know them today. The only source of compensation for any injured employee was by bringing suit in court, and very few workers had the means to bring suit. So was the case for the family members of victims of the Triangle Shirt Factory fire. In their civil suit against the owners, all of 23 families netted $75 in damages as compensation for the loss of their loved ones.

But the Triangle Factory tragedy was a major, energizing moment in the history of American workers compensation law. Before the end of 1911, 10 states had enacted mandatory workers’ compensation laws requiring employers to pay for medical care and lost wages resulting from injuries caused by the workplace. Today, workers’ compensation laws are in effect in every state in the nation.

David Iskowe began his health care career serving as Vice President for HealthAmerica Development, one of the industry’s first and largest for-profit HMO developers. He later co-founded FOCUS Healthcare, still one of the nation’s largest Workers’ Comp PPOs. In early 2002, Iskowe founded EnableComp to help hospitals manage their revenue cycle and reimbursement for Workers’ Compensation claims, and continues to be its Chairman.

A Time and a Place

It seems there are a couple of reasons that attorneys are often given the workers’ compensation claims. First, on may hospital A/R aging reports, workers’ compensations is lumped into “Other”. This group usually includes motor vehicle accidents and third party liability claims. Remember that “Time and Place for and Attorney” title? That is the time and place where they are an invaluable resource.  Workers’ compensation claims are often lumped into this “Other” category so when a provider outsources that group they tend to give it all to them. However, if you have decided to laser focus your outsourcing it would be wise to pinpoint the most effective outsourcing partner by claim type. We do one thing, workers’ compensation and we are the experts. The motor vehicle and third party liability should go to an expert in those areas, typically attorneys. Another reason these claims may get outsourced to attorneys is that some folks will take whatever you give them in order to get in the door. We are often asked to take on a great deal more from our clients and while we are more than willing to help them find the right person to help, we maintain our laser focus on one thing; workers’ compensation.  With our proprietary software and our highly trained experts we will recover every dollar the provider is entitled to without legal involvement.  There is a time and place for attorneys but workers’ compensation claims are necessarily the best use of their skills.

Jeff Tanner brings a wealth of healthcare industry experience to his current responsibilities as Chief Operations Officer. Before joining EnableComp, Tanner served as President of Elkhorn Consulting, a Nashville-based provider of revenue cycle management and other consulting services for the healthcare industry.

Recently, our team did something fun with a cause by participating in the Susan G. Komen “Race for the Cure” in Brentwood, Tennessee. Each year, our company adopts a community cause to support and this year we chose the “Race for the Cure.”  It was really rewarding to see many of our employees use a portion of their weekend to support this important cause. We did it as a team and we had fun doing it.  Here is some of our team and their families donning our pink for the day.

David Jones brings more than 30 years of achieving operational excellence to EnableComp in his role as President of the organization’s holding company, Complete Holdings Group. As a nationally respected executive coach, consultant, and author, Mr. Jones draws on his highly successful career with a Fortune 250 company, and, more recently, with his consulting firm which specialized in enabling companies to improve and sustain performance at all levels.

]]> http://www.enablecomp.com/blog/2010/10/14/we-value-fun/feed/ 0 http://www.enablecomp.com/blog/2010/10/07/the-best-part-of-my-day/ http://www.enablecomp.com/blog/2010/10/07/the-best-part-of-my-day/#comments Thu, 07 Oct 2010 07:59:28 +0000 Deb Miller http://www.enablecomp.com/blog/?p=185 I was working from my home office one afternoon a couple of weeks ago when the door bell rang.  Not expecting anything from FedEx, I was hesitant to open the door.  After all, I had a lot of work-related items on my “To-Do List” that I still needed to tackle.  In an effort to keep my dog from barking out of curiosity, I opened the door.  There stood a well dressed young man in his early thirties with a warm, friendly smile.  It had to have been the hottest day of the summer, and here stood a young professional in his best suit trying to hide the obvious sweat pouring off his head.  After a bit of small talk about my dog, he introduced himself and the financial planning firm he worked with.  I smiled kindly and listen to his spiel.  I then politely explained that both my father and brother are in the same business, and that they handle my investments.  He was very kind and didn’t push the issue with me, but gave me his information anyway.  He said he would be happy to work with anyone else I knew that may need his services.  One week later, I received a hand-written note in the mail from this aspiring financial planner.  He once again thanked me for my time, mentioned my dog by name, and inserted a few extra business cards that I could pass along to friends that may need his services.

That got me thinking…how many times in our business or professional lives do we miss the opportunity to go the extra mile for others? It seems so simple, a hand written thank you note but how often do we get caught up in the bigger tasks that we never stop to take the time to personally remember a prospect, client, friend or family member’s personal achievement, or even an act of kindness.

Needless to say, I have added one more task to my daily “To-Do List” by taking the time to personally touch one person with a card, phone call or action. I have to be honest…it’s now the best part of my day!

Heidi Hofmeister, Account Manager Heidi serves as the primary contact for EnableComp’s various clients. Equally important, she serves as their champion – making sure that their needs are consistently met and their concerns immediately dealt with. With fifteen years’ healthcare industry experience, Hofmeister has an insider’s perspective on the community hospital and physician office settings. Heidi and her trusted side-kick, Deuce, live in Florida.

Little did I know that later in my career I would be consulting for, and eventually running, a company that focused on the smallest segment of that report that I used to review.  At first I thought, well good for them. They found a little pocket where they can eke out a living and make some money helping hospitals. When I started looking however at the amounts that they were recovering for their clients I thought that something must be wrong. These clients must have had way higher percentages of WC than I did. Nope, actually less. More like 1% to 2%. Okay, well the client must just not have a process. Nope,most of them believed there was not a problem and that they had it covered with an array of processes, systems, and people.

So where were all of these recovered dollars coming from? When I worked with David Iskowe and David White and they educated me on the complexities of WC I immediately had a flashback to that report that said 3%. I have to this day, and will for many more, wondered just how much money we left in that bucket. As administrators we focus on the big components of our hospitals, as we should, and basically hope that the little stuff is going all right. We cannot pull already limited resources from the big buckets to look at the little cup on the end of the report. But, what we can do is maintain our focus on the big buckets while partnering with someone to make sure that little cup is not leaking cash with an unseen hole in the bottom.

At EnableComp we do not sit under the cup and continue to let cash flow escape from your organization. We come in and grab that bucket of cash that left on the table and then we tell you how we did it so that the hole gets plugged and the cup is filled with the revenue that you are entitled to for services provided. I would be lying to you if I said that you would then never miss another dollar but I will promise you that you will miss a lot less. EnableComp will be there to continually check behind you and make certain that every dollar earned is in your account instead on someone else’s table.

Jeff Tanner brings a wealth of healthcare industry experience to his current responsibilities as Chief Operations Officer. Before joining EnableComp, Tanner served as President of Elkhorn Consulting, a Nashville-based provider of revenue cycle management and other consulting services for the healthcare industry.

While we understand the payer’s dilemma, it still just doesn’t seem right. Granted, there are a very few medical providers who have hurt the image of all regarding fraud and system abuse. But let’s get realistic…these are the exception, and should not define the default behavior of the claims handlers. It is not unusual for a Workers’ Comp Insurer or TPA to make a “first pass” payment of only 25% of the total dollars allowed on a large hospital inpatient claim.  Then the battle looms over what kind, and how much, documentation is needed to satisfy that individual insurer or its TPA’s definition of a “clean claim”.  It’s a very expensive problem for both sides, not just for the healthcare provider. Particularly in light of the following;  on average, after a payer requests and a provider goes about pulling mountains of medical records to “prove” that denied services were actually delivered, the net error rate on large inpatient bills (i.e., services overbilled less services never billed) is usually less than 3%.

Action Call to Providers Begin by formally tracking the results of medical bill audits performed by payers (or their agents) on your larger bills. Develop your own Net Error Rates to “prove” your track record.

This is the first of a series of commentaries that will explore ways to strike a more reasonable balance between Deny & Prove vs. Pay & Pursue claims handling practices. The comments of others, whether on behalf of the payer or the provider communities, will be both greatly welcomed and extremely appreciated.

David Iskowe began his health care career serving as Vice President for HealthAmerica Development, one of the industry’s first and largest for-profit HMO developers. He later co-founded FOCUS Healthcare, still one of the nation’s largest Workers’ Comp PPOs. In early 2002, Iskowe founded EnableComp to help hospitals manage their revenue cycle and reimbursement for Workers’ Compensation claims, and continues to be its Chairman.

Exceeding expectations is more about how we perform. Interestingly enough, most of our clients start out with low expectations about what we’ll recover for them in their zero-balance work comp accounts. They just don’t believe they’ve left much on the table. Either their team has done a great job (which most do), or they just can’t imagine there is as much in work comp as we typically find. In their defense, work comp is a ridiculously complicated reimbursement class…and, at 1.5-3% of their total gross patient revenue, it often flies under their radar. So our challenge becomes convincing a potential client that it is worth the investment of time and effort to give us some billing and payment data. We understand, these folks are bombarded by vendors offering big promises. The difference with us is that we deliver. And if you don’t believe it, you can ask any client we have ever had…because we’ve never lost one.

Hospitals are under intense pressures these days, with every dollar being critical. Because we only get paid when we find money…and we find revenue that was left behind, every dollar we identify and recover drops straight to the bottom line. As someone responsible for the bottom line of our company, I can’t help but think about how hard a hospital has to work to generate the revenue that would yield profits anywhere near the kind of money we can help them recover. For example, we recently surpassed the $2 million mark in recoveries for a Level-1 trauma center in Tennessee. Based on standard industry profit margins, they would have had to generate more than $66 million additional gross patient revenue to yield those margins. You can bet your bottom dollar that this is an ecstatic customer…and is happy to share it.

David Jones brings more than 30 years of achieving operational excellence to EnableComp in his role as President of the organization’s holding company, Complete Holdings Group. As a nationally respected executive coach, consultant, and author, Mr. Jones draws on his highly successful career with a Fortune 250 company, and, more recently, with his consulting firm which specialized in enabling companies to improve and sustain performance at all levels.

In contracts with managed care organizations that span coverage types (like Aetna for example), rates intended for Group Health patients are often applied to Workers’ Comp bills.  While the number of patients impacted by this scenario is relatively small, the pricing impact can be stunning.

Here’s what happens. Most state mandated fee schedules include language that requires payers to reimburse individual claims at the lesser of the Fee Schedule or the PPO rate.  So even if that “lesser of” language is not part of the hospital’s contract, the payers apply the PPO rate only when it is to their advantage.  This often leads to Workers’ Comp discounts well below the intended contract.  We’ve seen this adversely impact some hospitals by nearly half a million dollars per year on a business segment yielding only five to six million.

Hospitals can fix these situations by opting out of the MCO’s Workers’ Comp network with little or no impact to patient flow.  To remain in the network, add a simple Workers’ Comp specific pricing addendum for a nominal 3% to 5% discount below the State Fee Schedule.  Unfair reductions will be eliminated while the hospital remains on the PPO’s list of Participating Providers.

A small time investment could yield a big savings!

David White, VP of Operations for EnableComp With more than two decades of experience in the Workers’ Comp industry, David White brings a wealth of specialized expertise about the system’s payment practices and complex regulations. A member of the EnableComp team since its founding in 2001, he has been instrumental in the development of its proprietary technologies and operating processes. In addition, White has worked closely with state regulators to clarify payment policies and share provider perspectives.

At EnableComp, we have six core values and all of them impact our clients either directly or indirectly. Over the next several weeks, I will spend a little time sharing thoughts on each of our six core values. Our first value is Uncompromising Integrity which simply means that our word is our bond and our clients can count of us to deliver on our promises and commitments. We believe integrity is at the heart of everything we do. It seems we live in a world where it’s too easy to promise one thing and deliver another. Whatever happened to the simple handshake between two parties that sealed a business deal?

At EnableComp, we work hard to deliver on all our commitments each and every time. However, we don’t want to just deliver on what we promised, we want to over-deliver at every opportunity. Maybe that’s why since the company was started in 2002 we’ve never had a single client take their business somewhere else.

David Jones brings more than 30 years of achieving operational excellence to EnableComp in his role as President of the organization’s holding company, Complete Holdings Group. As a nationally respected executive coach, consultant, and author, Mr. Jones draws on his highly successful career with a Fortune 250 company, and, more recently, with his consulting firm which specialized in enabling companies to improve and sustain performance at all levels.

In the world of workers’ compensation reimbursement, we have found that incorrect claims processing is even more rampant. In fact, 30% of all workers’ compensation claims are paid incorrectly. We have found that 18% of incorrect workers’ comp claims are underpaid by the P&C insurers responsible for payment. Sadly, that lost revenue flies under the radar for most providers. The culprit with many of these underpayments is also related to a lack of standardization of rules from state to state, or from facility to facility for that matter. But to make matters worse, it is compounded by the tremendous complexity of the rules, the archaic paper-based system that remains the foundation of work comp, and a plethora of compliance and jurisdictional issues that change rapidly.

What does this mean to you? Well, if collecting every penny in your revenue cycle is important then it means paying attention to every piece of your pie. The rewards of doing so will be sweet.

Click here to read the entire article HealthLeaders Media article “Seven Largest Insurers Incorrectly Pay One in Five Claims, Says AMA” http://www.healthleadersmedia.com/content_redirect.cfm?content_id=252468

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