The Clock Is Working Against Your TPL Recoveries

When you transport a patient hurt in an auto accident or on a job site, third party liability is almost always the highest-paying option. Liability carriers reimburse at much higher rates than Medicare, Medicaid, or commercial plans. They also pay without copays or deductibles. That means less collection work for your billing team and no surprise bills for your patient. The catch is that liability information is rarely in your PCR on day one. The longer it stays hidden, the harder it gets to find.

We recently pulled hit rate data across a large volume of TPL referrals. The pattern was clear. Accounts sent to us within 1-10 days of service hit at 55.46%. That rate drops sharply over the next few weeks and falls to just 39.50% for accounts sent after 60 days. That is a 16 point swing driven by timing alone.

Claims data ages fast. Adjusters close files. Insurance details get updated. The digital footprint a TPL scrub relies on starts to fade. The accounts you sit on are not just late. They are less likely to be recovered at all.

Timing matters for another reason too. PIP and MedPay coverage have limits. The first provider to find the claim and bill it often uses up most or all of that coverage. If you are second or third in line, the money may already be gone. A strong TPL scrub takes a few days, so every day you hold an account is a day the data ages and another provider gets ahead of you in line.

The fix is simple. Flag potential TPL accounts at intake and route them to scrubbing within days, not weeks. Many providers still rely on patient contact to gather this information, but that approach has a low yield and creates real administrative burden. When that fails, the easy path is to bill Medicare, Medicaid, or the commercial payer and move on. That feels efficient, but it locks in a lower payment and puts copays and deductibles on the patient. Faster TPL submission protects your hit rate, lifts your reimbursement per trip, reduces work for your billing team, and keeps patients from paying out of pocket for an injury someone else's insurance should cover. If you would like SGS to run a TPL review on a recent batch of your accounts and show you what your current timing is costing you, reach out and we will set it up.

Brian Choate, Co-Founder & Managing Partner, Solutions Group