Patients may enroll in multiple insurance plans, which may mean that there is an overlap in their benefits. With 41% of Americans (72 million people) experiencing medical billing issues, coordination of benefits issues is just one problem you’ll deal with. When you face a COB denial of the claim you send to the insurance provider, you need to know what that means and how you can address the situation.
A COB or coordination of benefits denial is one of the most common issues you may face in medical billing. With medical billing errors and issues, the care of your patients may be directly affected. So, you need to know what COB is, its purpose, and what you can do to resolve any issues. TempDev can help you to resolve COB denials and other medical billing challenges.
What is the Coordination of Benefits (COB)?
COB stands for Coordination of Benefits, which is how your patients’ insurance benefits are applied. To resolve COB issues, the medical provider needs to determine the primary provider and secondary provider for the patient. Often times patients will forget they have secondary insurance or incorrectly provide it as their primary insurance.
If your patient only has a single insurance provider, you shouldn’t have to worry about COB. You still might experience issues if the patient recently switched insurance providers or if there is a paperwork discrepancy between insurance providers and benefits.
Why is COB Important?
COB sounds simple and easy to process, but it can cause significant issues when you’ve submitted a claim as part of your medical billing process. It’s not always easy for the insurance company and you to determine which insurance company should be the primary and which secondary. Here’s why coordination of benefits is important:
While you wait for the insurance providers to figure out which one is the primary and which one is the secondary, your claim is usually in limbo. You won’t be paid until the issue is resolved.
While you don’t have any direct control over which insurance provider will cover your patient’s claim, you still need to follow up several times to ensure that the claim doesn’t get lost and ignored in the shuffle.
Issues with the coordination of benefits could mean that you’ll need to charge the patient for the cost of services. Then, they can seek reimbursement from the insurance provider.
What Are the Benefits of COB?
Coordination of benefits allows you to complete your medical billing process. In the best-case scenarios, it should be clear and straightforward without the potential for duplicate billing issues. Here are a few of the benefits of the COB process.
The main goal of COB is to ensure that any claim is correctly processed. The insurance provider needs to identify the health benefits and then coordinate the correct payment details.
When your patient has dual coverage, the insurance provider must coordinate benefits so that the total payments do not exceed 100% of the billed claim amount.
In some cases, you can help to streamline the COB process by sharing the health insurance eligibility information with the insurance provider.
Your patient may be carrying a secondary insurance plan to help with out-of-pocket expenses, but you still may need to keep track of their co-pay requirements.
Is Medicare Always the Primary Payer in COB?
In some cases, Medicare is the default primary payer for benefits coverage. For example, if your patient is aged 65+ or if your patient is disabled, Medicare is typically the primary payer. If the insurance provider is an Employer Group Health Plan (GHP), Medicare is usually the secondary.
It’s still important for you to check all the benefits details and follow up to ensure that your claim is processed correctly. With 81 million people expected to be covered by Medicare by 2030, It's more important than ever to verify coverage and all the patient’s medical details to avoid delays, discrepancies, and miscommunication.
TempDev can consult with you on how to optimize your NextGen practice management system to prepare for and mitigate any issues related to Medicare or other insurance coverage.
How TempDev Can Help with Your Coordination of Benefits
TempDev’s revenue cycle consultants offer support and consulting for issues related to your Coordination of Benefits. With automation, dashboards, revenue cycle consulting, and templates, we offer the tools and resources you need to identify and resolve medical billing issues quickly.
With top tips and tricks, we make sure you’re successful with your medical billing. Our goal is to streamline your medical billing process as much as possible so that you’re able to correctly bill and receive the correct reimbursement, which should reflect a healthy financial system and a successful revenue cycle.
Contact us here or by calling us at 888.TEMP.DEV to get the help you need with the coordination of benefits.
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