Motor Vehicle Accident
VA / Tricare Claims Processing
Eligibility and Enrollment Services
Automobile accident patients commonly become classified as “self-pay” despite available automobile insurance policies that could pay 100% of billed charges. Even when other coverage is available, automobile insurance commonly should be primary and almost always pays rates higher than other alternatives.
Our high level MVA practice includes:
- Providers can electronically transmit suspected MVA claims upon admission
- The Aspirion team investigates all potential coverage areas including first party automobile, medical payments, PIP, health insurance, auto liability insurance
- Our staffed attorneys will file liens, if appropriate, and letters of protection (if lien prohibited)
- If coverage is unavailable or has been exhausted, we provide verification to the provider so that claim can be filed with health insurance with proof that coordination of benefits has been attempted
- If coverage is verified, we file the claim and follow up to ensure payment to the hospital
Workers Compensation Claims
Workers Compensation claims are often underpaid or inappropriately denied. Most medical providers do not have the expertise or resources to collect everything they are owed on these claims. Aspirion typically receives workers comp claims day 1 which results in more reimbursement to our providers.
Our typical process includes:
- Investigate and determine the correct payer and/or additional insurance(s) that may exist
- Obtain necessary paperwork to submit clean claims
- Aggressively follow up until the claim is resolved and paid
- Provide attorney support to represent the provider as a direct party to insure payment, when necessary
- Pursue penalties and interest whenever appropriate
- Provide hospital staff training for approval processes of non-emergency claims
VA / Tricare
- Currently, over 6 million (two-thirds of all) veterans are actively receiving treatment. Recent changes in legislation and increasing volumes of service discharges are substantially increasing the volume of veterans traffic to non-VA providers.
- The VA claims process is reliably tedious, time intensive, and complicated. Coupled with commonly low reimbursement rates, providers find it difficult and cost-prohibitive to adequately pursue these reimbursements
- Aspirion’s Patient Access training helps eliminate eligibility-related denials and improves patient experience for our veterans
- Tricare claims share many of the same complications as VA claims, and rules and regulations continue to evolve/change
- Our Aspirion VA/Tricare team has experience and expertise to manage the billing and collections of this difficult RCM segment
Up to 20% of all claims submitted to providers are denied. Astonishingly, up to two-thirds of those are never appealed. While these claims are difficult to appeal, Aspirion commonly experiences a 90%+ denial turnover rate on fresh denied claims and 70%+ turnover rate on aged denied claims. Instead of writing off denied claims, Aspirion affords providers the opportunity to collect significant reimbursement on these challenging claims.
We have over 90 attorneys and a dozen clinicians on staff to improve reimbursement on denials. And, while we do not practice law, the skilled background of our denials team significantly improves results for our provider partners. Similarly to our other service lines, Aspirion is nearly 100% contingency based, so we only get paid when our providers see results.
OOS Medicaid proves to be one of the most complex segments of a segment of RCM commonly referred to as complex claims. Most complex claims vendors avoid it entirely and most providers write them off. At Aspirion we believe that we are not offering a complex claims service without this segment.
Why is it so complex?
- OOS Medicaid claims can be difficult to identify given the emergence of Managed Care
- Billing requirements vary significantly from state to state
- These varying requirements change frequently making them very difficult to manage
- All providers must be credentialed (physician and facilities enrolled) in the covering state before reimbursement can occur (almost no providers are proactively credentialed in other states)
- Re-credentialing is necessary with varying timelines; again, rules are different for each state
Aspirion manages all of the above complexity while ensuring timely billing and follow up to maximize reimbursements and to shorten the A/R cycle. We leverage electronic claim submission, produce custom reporting, and adhere to strict data security standards to ensure this often overlooked segment of provider RCM receives the care and attention that it deserves.
Medicaid Eligibility and Enrollment
Aspirion offers E&E services that primarily focus on in-patient and out-patient Medicaid eligibility and enrollment. We commonly staff on-site at hospitals and in emergency departments, if applicable. We further pursue Medicaid E&E post discharge in instances where we do not staff the hospital or when client’s choose our off-site model.
Beyond traditional Medicaid E&E, Aspirion also supports:
- Presumptive Eligibility
- County Indigent Program
- Railroad Retirement Benefits
- Crime Victim’s Assistance
- Disability through the Social Security Administration (SSI & SSDI)
- Disabled Widower’s Benefits
- Accelerated Programs for Disability Approval including TERI Applications, Compassionate Allowances, Presumptive Disability, and COBRA
- Veteran’s Benefits
- Indian Health Services
- Expedited Medicare