1 / 23

Claims Management Best Practices: Thinking Beyond Resolution

Claims Management Best Practices. Primary GoalsConsistent application of insurance coverageConsistent claims reserving practicesImplemented litigation management plansAggressive management of defense counselProper use of mediationDecreased ALAE (allocated loss expense). Claims Management Best

salvatore
Download Presentation

Claims Management Best Practices: Thinking Beyond Resolution

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Claims Management Best Practices: Thinking Beyond Resolution Pamela L. Popp, MA, JD, DFASHRM, CPHRM, President, ASHRM Stanford University Medical Center

    2. Claims Management Best Practices Primary Goals Consistent application of insurance coverage Consistent claims reserving practices Implemented litigation management plans Aggressive management of defense counsel Proper use of mediation Decreased ALAE (allocated loss expense)

    3. Claims Management Best Practices Highest areas of liability payouts: Failure to diagnose Medication errors Surgical errors Obstetrical errors

    4. Claims Management Best Practices

    5. Claims Management Best Practices

    6. Claims Management Best Practices Claims are more than losses… they are reflective of how the patient base perceives the facility and the care rendered…. What does your claims history say about your program?

    7. Claims Management Best Practices “Next level” goals Evidence based risk management Completeness of trending information Strength of risk management database Data analysis options

    8. Claims Management Best Practices Advanced analysis levels Proactive Preventative Remedial Facilitative

    9. Claims Management Best Practices I. Proactive analysis New business assessments Return on investment analysis New liability theories What risks can we prevent?

    10. Claims Management Best Practices II. Preventative analysis Focused new employee orientation Resident simulation scenarios Comparative/industry benchmarking What should we be trying to prevent?

    11. Claims Management Best Practices

    12. Claims Management Best Practices

    13. Claims Management Best Practices

    15. Claims Management Best Practices III. Remedial analysis Prioritized criteria for reporting How will we know if they still happen?

    16. The following matters should be reported from the facility under the ‘Adverse Event’ procedures: Apgar scores of less than 4 at 10 minutes Placental abruptions Uterine ruptures Neonates intubated within the first 20 minutes of life Amniotic fluid embolisms Shoulder dystocias Any unusual birth or nursery circumstance

    17. Claims Management Best Practices

    18. Claims Management Best Practices IV. Facilitative analysis Standardized investigations Standardized defenses Expert database Checklists What can we do to handle this situation, and others like it, as efficiently as possible?

    19. Claims Management Best Practices

    20. Claims Management Best Practices V. Remedial analysis Peer review/credentialing feedback Post mortem analysis Identified risk management issues What can we do to strengthen our defense in this situation and others like it?

    21. Claims Management Best Practices

    23. Thank you! ppopp@stanfordmed.org

More Related