Staffing Cuts Can Be Avoided Thanks to the Federal ERISA Appeals Process

Many healthcare companies, ranging from the large (hospitals) to the small (general clinics) and everything in between, are trying to cut costs due to financial pressures. As a result, this has trickled down to the staffing agencies that supply workers to these healthcare locations. Although there aren’t any signs that patients will be affected by these cost-cutting measures, as nurses and doctors are still hired in appropriate numbers, the bigger issue here is that all of this could be avoided with proper financial management and the use of Federal ERISA appeals in order to get the money that is lingering in the form of unpaid commercial health insurance claims.

Staffing Cuts Are Occurring (Almost) Across the Board

According to a recent report, “The pressure healthcare providers face to reduce costs is forcing changes among staffing companies.” One representative from a staffing company pointed out that “Healthcare providers are grappling with the ever-rising pressure to control costs,” said S&P credit analyst Sarah Kahn in a news release. “While they have turned to outsourcing staffing, their intense focus on cost-cutting has put significant pressure on staffing companies to lower prices, increase the value they add by either specializing or expanding their menu of services, or both.” In addition to this, “The agency said it expects staffing companies will have fewer clients if they don’t offer what hospitals need to reach their value-based care goals.”

It makes sense that when one type of business, in this case, the healthcare industry, decides to cut costs by hiring or keeping fewer contract employees, everything would trickle down to another industry. In this case, it’s the staffing agency. In order to maintain their current levels of service, the staffing agency either needs to diversify their specialization or the hospitals that they send contract employees to would need to begin hiring people at the same levels once again. Since budget cuts seem to be in the future of most hospitals, the first option seems to be the best for the time being.

A Larger Focus on Cost Containment

Even hospitals and healthcare companies that are in good financial condition seem to be cutting back on their costs. One expert stated that “Today, many traditional cost containment strategies have focused on cutting overhead like human capital, facility, and supply chain costs. But supply and facility costs can only be cut so far, and cutting wages and employee hours is short-sighted, as these strategies contribute to employee burnout and increasing staff turnover rates across the industry. If hospitals truly want to reduce waste and contain costs, they need to look to the real source of the problem: operational inefficiencies.”

Operational inefficiencies, which include having a large amount of support staff, are clearly the issue, according to these same experts. They went on to say, “One out of every three dollars spent on healthcare each year is spent on the repetitive, high-volume tasks that make up the administrative side of healthcare. Increasing regulatory requirements are only adding to the burden – an American Hospital Association study found that an average size hospital today dedicates 59 full-time employees to regulatory compliance alone, over a quarter of which are clinical staff.”

In addition to this, computer programs and data seem to be at the heart of the issue, “At the heart of these process inefficiencies is the lack of interoperability between systems. Data has to be manually pulled and entered from one screen to another, over and over again, making human error inevitable. And with increasingly complex regulatory needs and requirements, an overhaul of the entire system is far-fetched. Hospitals need solutions that work with the systems and processes they already have in place – and this is where organizations have a tremendous opportunity to create financial impact with artificial intelligence.”

This artificial intelligence is poised to be a good solution to the problem, “Artificial intelligence and robotic process automation have gone from a futuristic buzzword to real-world solutions providing enormous value at health systems across the country. And while the innovative technologies are being explored for multiple areas, from AI-assisted surgeries to diagnostics, they’re uniquely positioned to solve many of the administrative flaws and headaches that cause so much waste.” All of these are solid solutions, but there’s yet another that none have mentioned thus far – collecting on those unpaid and underpaid commercial health insurance claims.


The Claims Collection Process

When a patient goes to a hospital to get a procedure completed, they meet with a doctor or surgeon who writes down everything. Nurses and members of the support staff get involved in this process as well, noting all of this on the person’s chart. That chart then goes to a medical coder who translates it into terms and codes that the billing department can handle. From there, the billing employee sends the claim to the correct health insurance company in order to collect payment. This commercial health insurance company has several options, ranging from paying the claim in full to paying only part of it or sending it back completely unpaid. These unpaid claims pose a problem.

Every healthcare company – from hospitals to outpatient surgical centers – receive three state-level appeals on these unpaid claims. This means that they can send them back a total of three times. If the claims are still unpaid, they end up in a debt bucket. However, these claims aren’t actually finished, many people just believe that they are. They can be sent out as Federal ERISA appeals that ensure that the claims will be paid. Many hospital workers don’t know how to do this though, as it requires some specialization in the field.

This Is Where We Come In

ERISA Recovery is a company that specializes in the Federal ERISA appeals process and getting those unpaid commercial health insurance claims, well, paid. Contact us today to see how we can help. You can reach us through our website or via phone. We even have a guarantee!