By: Michele Hibbert-Iacobacci, CCSP, OHCC
Vice President, Information Management & Support, Mitchell Casualty Solutions Group
Karen Ritchie, Director, Regulatory Affairs and Educational Services, Mitchell Casualty Solutions Group
Suzi Strong, Senior Manager, Regulatory Affairs, Mitchell Casualty Solutions Group
Supporting End Users To Make The Right Decision The First Time
Property and Casualty insurance carriers have a daunting task when it comes to handling injury claims within the rapidly evolving world of regulatory compliance. As requirements constantly evolve, the number of insurance policies and injury claims an insurer/payor services in each jurisdiction can create an abundance of complex and often-confusing set of rules and regulations to follow.
Moreover, throughout time, both medical bill review and regulatory compliance have become increasingly complex. Long gone are the days of flat-rate pay, percentage of charge and other simple reimbursement methods. There are always new regulations introduced for cost containment and management. Introduction of new rules, statutes and regulations occurs on a state-by-state basis without comparison to other states. Essentially, each state in property and casualty has been referred to as its own country.
As more guidelines are applied, managing large quantities of information has proven to be very challenging. Additionally, ensuring compliance is prompt, comprehensive, accurate and consistent is becoming more and more difficult as state regulators propose and implement an ever-changing series of requirements around bill evaluation and payment. Within property and casualty, payors not only have to stay well informed of these mandates, but also ensure timely and accurate implementation of process updates to implement new requirements in place. Having information and striving for proactive engagement in applying these rules creates a more proficient and streamlined claims operation.
So how can payors stay abreast of the changes and keep up with the regulatory environment?
Through access of a single repository and web-based portal comprising of the most current regulatory rules and jurisdiction-based information.
A web-based portal serves as an organized “single source of truth” comprising all compliance-related information including state regulations, fee schedule administration, bill review rules, state reporting and so on. There are thousands, if not, millions of pieces of information and documents around regulatory changes pertaining to specific states in all lines of businesses and service types. Having a place to find all of this information available at a central location becomes very valuable to payors.
A single repository should allow readily accessible compliance-based content for the end user.
Availability with the most current content 24/7/365 at an end user's fingertips is important as it is supporting the claims examiner, nurse, bill reviewer and others to provide real-time, accurate data to help make the right decision the first time.
The content should be easily digestible and easy to understand.
Regulations, statutes and legislation can contain ambiguity and subjectivity in the language and rules that accompany not only bill review guidelines but also a majority of compliance-related content. This can cause confusion or uncertainty for claims payors and others like consumers who depend upon clarity. The information shared needs to translate into easy to read and easy to understand terminology.
Notifications that alert users of important legislative updates and matters.
In the past, many organizations faced the challenge of ensuring content reached customers in the shortest possible amount of time. Automated alerts and integrated social media channels makes sharing content more efficient. Through timely updates, users can gain immediate visibility into the regulatory requirements and environment affecting the property and casualty industry.