Workers' Compensation Program Case Study

Convergent collects Worker's compensation claims for large pacific northwest health system

The Challenge

A not-for-profit health system serving communities in the Pacific Northwest was noticing a large increase of denied/unpaid Workers’ Compensation Claims, coupled with an overburdened staff unable to manage, follow-up, and adjudicate said claims. Executives decided to solicit Convergent’s expertise in order to determine next steps. During initial discussions, Convergent identified two issues resulting in the lower than average cash collections they were experiencing:

  • Improper handling of Workers’ Compensation accounts
  • Lack of consistent follow-up regarding medical necessity and third-party denials

The Solution

The health system contracted with Convergent Revenue Cycle Management, allowing us to take over their Day-1 Workers’ Compensation and Insurance Denials Programs. To ensure a successful partnership and maximize recoveries, Convergent assigned a senior attorney and senior client representative to work closely with their executive team. Convergent’s unique blend of expert resources, combined with customized technology and proprietary workflows, provided a best in class solution to address the growing need of delayed claim resolution and low reimbursement.

The Results

Convergent delivered on our promise to apply expertise and experience to drive cash collections for our client, resulting in 85% claim resolution within 90 days of implementation. Over 19 months, Convergent collected $58.1M from Workers Compensation accounts. Additionally, with claim management and follow-up being outsourced, the health system has been able to reallocate internal resources to better serve the organization.

CRCM takes an aggressive approach to obtain faster and higher of reimbursement for WC claims. Our specialized, attorney-led teams use their deep understanding of State & Federal regulations, and rigorous follow-up approach to collect what is legally due from every claim.

  • Dedicated teams to understand each state’s rules and laws
  • Nationwide fee schedule calculator
  • Underpaid claim specialists
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