Third Party Liability Program

 

 

COMPSPEC's Comprehensive Third Party Recovery Program is a well established and successful program employing several distinct means of identifying potential third party liability cases and the resources necessary to bring each case to resolution; often obtaining full charges reimbursement for our clients. COMPSPEC's Comprehensive Third Party Recovery Program consists of four specific services each of which is described below.  This program has been designed in such a manner as to have little to no disruptive effect on the client's staff nor demand upon client resources.

 

 

●  RETROSPECTIVE REVIEW AND RECOVERY SERVICES

  • ACCOUNT SCREENING - COMPSPEC proposes to conduct a retrospective review of closed patient accounts, (both inpatient and outpatient and including all financial classes), for the purpose of identifying all accounts evidencing potential third party responsibility.  The retrospective review procedures will identify opportunities to recover the client's full fees (or contractual adjustment 'unpaid' portions where permitted by statute), from responsible third parties where the CLIENT has taken substantial reductions in reimbursement from its usual and customary full charges and fees.

     

    This program will utilize information, (such as ICD-9 diagnostic codes and payment history), secured from the CLIENT's patient accounts database to identify accounts for further investigation relevant to third party responsibility.  Where potential third party recovery opportunities are identified, COMPSPEC staff will conduct further research and investigation on an account-by-account basis in order to secure the statutory lien and/or otherwise maximize the CLIENT's reimbursement.

     

  • INVESTIGATION & FOLLOW-UP - COMPSPEC employs a widely respected collections and skip tracing system that may be used to locate patients or other responsible parties.  Wherever possible COMPSPEC will contact patients' attorneys directly, however, when necessary COMPSPEC may contact patients to identify their legal representatives and/or to secure permission to access police reports and other pertinent documents and information helpful to the pursuit of recoveries. COMPSPEC may also access court records and docket schedules for jurisdictions within and beyond California as well as public records of actions instituted by or on behalf of the California Department of Health Services in its thorough research of third party liability and recovery opportunities..

  • CHARGE AUDITS - As an added benefit, (and at no additional cost to the CLIENT), where appropriate and upon selected accounts, COMPSPEC will conduct a detailed audit of charges to optimize the CLIENT's claim for additional compensation and validate unpaid balances.  It is not uncommon, particularly on large and complex cases, for the CLIENT to inadvertently omit substantial charges.


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  • COMPSPEC further proposes to contact selected attending physicians and other practitioners, contractors, etc. SPEC further proposes to contact selected attending physicians and other practitioners, contractors, etc. and offer to represent their claims as well as those of the CLIENT.

     

    Any agreements made between COMPSPEC and such physicians, practitioners, contractors, etc. SPEC and such physicians, practitioners, contractors, etc. shall be completely separate and apart from the agreement with the CLIENT and subject to fees negotiated with such practitioners on a case-by-case basis.

     

    While this process will be entirely separate and apart from the engagement with the CLIENT hospital, COMPSPEC feels that the inclusion of such physicians, practitioners, and contractors in this recovery program will strengthen the bonds between the provider community and the CLIENT.

    

●  REVIEW OF SUBPOENAS AND REQUESTS FOR RECORDS

  • COMPSPEC proposes to conduct a review (both retrospectively and on an ongoing basis), of all subpoenas and requests for medical records and/or bills received by the CLIENT, as an additional effort to identify potentially liable third parties.  In appropriate cases, COMPSPEC may recommend the subpoena or request be copied to the CLIENT's Risk Manager or Counsel in the event of a potential allegation of medical malpractice, etc.

 

    

●  CONCURRENT REVIEW AND RECOVERY SERVICES

  • COMPSPEC also proposes to conduct a concurrent program to screen open accounts, inpatient and outpatient to include all financial classes, in an effort to identify potential third party liability cases.  This procedure will include review of information similar to that described above for the Retrospective Review and Recovery Services, but as well will include training for the CLIENT's admissions and registration staff, financial counselors, and billing and collections staff to ensure early identification of potential third party recovery accounts.