The healthcare industry offers a number of health insurance plans for patients. A patient may receive duplicate benefits if they enroll in multiple health insurance programs. COB requirements from CMS prevent medical billing benefit overlap.
Medical billing mistakes and difficulties may negatively impact your patient’s care. Therefore, you must comprehend what COB is, what it seeks to do, and how to approach problems that arise with it. You can get assistance from RCM Matter to overcome COB denials and other difficulties with medical billing.
What is COB in medical billing?
Coordination of Benefits, or COB, refers to identifying whether a health insurance company is a primary or secondary payer. The objective is to offer medical claim benefits to a patient with numerous health insurance policies. While processing medical claims, COB makes it considerably simpler to ascertain the primary payer’s obligations and decide the secondary payer’s participation.
How does COB work in medical billing?
The fundamental objective of benefit coordination is to simplify the patient payment process. The patient’s medical care costs will first be covered by their primary insurance provider when they use it. If the patient’s insurance plan covers the procedure, the secondary insurance company will cover the remaining 100% of therapy costs. No insurance policy can cover 100% of healthcare costs. With multiple insurance plans, it is, therefore, impossible to receive double benefits.
What are the purposes of COB?
According to CMS, the COB process is meant to achieve the following goals.
Paying Claims Correctly
It makes sure that medical claims are paid accurately and without error. This is accomplished by figuring out the Medicare beneficiary’s medical benefits and organizing the payment procedure. It is crucial to ensure that the significant payer (either Medicare or another insurance company) pays first to simplify the payment process.
Exchange of Medicare Eligibility Information
The secondary payer(s) must be informed of the Medicare eligibility information and secondary payments must be made to maintain transparency. However, in cases of automatic crossover claims, a contract between the BCRC (Benefits Coordination and Recovery Center) and private insurance providers (for the BCRC) is necessary.
No Double Payments
The main goal is to avoid double billing when there is dual coverage. The payment should be at least 100% of the entire claim.
Administration of Part D Benefits
The method determines a Medicare beneficiary’s True out-of-pocket (TrOOP) costs. This helps ensure that the Part D benefits are correctly administered.
What makes it significant?
It’s crucial for patients as well as insurance companies. It helps patients and insurers solve problems like:
- Preventing the payment of the same claim by both insurance carriers.
- Aiding in lowering the price of insurance premiums.
- Helping the provider determine which policy to bill as primary, secondary, or tertiary.
- Helping to maintain the price of prescription drugs as low as possible.
- Avoiding any circumstances where a patient or insurer is required to foot the bill because of a lack of organization.
Is Medicare generally the primary payer in COB?
Medicare serves as the primary payer by default in various situations. For instance, Medicare is frequently the main payer if your patient is over 65 or has a disability. Medicare is typically the secondary option if the insurer is an Employer Group Health Plan (GHP).
You must still verify all the benefits’ specifics and take further action to ensure your claim is processed correctly. By 2030, Medicare is anticipated to be used by 81 million people. Verify coverage and the patient’s medical history to avoid delays, conflicts, and inaccuracies.
FAQs
Q-01: How do I deal with benefit coordination?
Your insurance company will need you to list any extra health policies. They may mail you a form, tell you to complete the details online, or call you. You have to communicate with your insurance provider and supply the necessary information to fulfill the coordination of benefits requirements.
In case of an issue, keep a copy of each document. Write down the representative’s name and call the reference number when you call the insurance company.
Q-02: What happens if benefit coordination still needs to be finished?
Your insurance provider might only pay claims once the situation is rectified if the coordination of benefits status is updated. There’s a chance they’ll write off the debt as “patient responsibility,” leaving you to pay the entire visit cost. If you follow the insurance company’s rules, you’ll save time.
Q-03: Do I need to complete this if I only have one health insurance policy?
Yes. Your insurance provider can only pay your claims once verification is received, although you currently only have one health insurance plan. Insurance companies regularly check the coordination of benefits and may even demand it if there are no other coverages to coordinate. The billing procedure will go more smoothly for you as a customer if you abide by their instructions.
Q-04: How can I contact my insurance provider about benefit coordination?
Phone, online, and mail are the most common ways to contact your insurance company.
Q-05: Which data should I collect?
You should compile the following paperwork:
- IDs from every other health insurance program.
- Everyone on your plan who is also covered by another insurance plan must provide their full name and date of birth.
Q-06: Where can I obtain details about policies?
Check the ID cards from all other insurance plans for the names of everybody else your plan covers, the group number, and the policy number. Please be aware that your policy number may also be your member ID, participant ID, or another similar term.
Conclusion
The regularization of benefit coordination aims to end the problems with duplicate reimbursement and eliminate healthcare liability for all concerned insurance companies. Patients, payers, and clinicians must follow a set of guidelines to guarantee that primary care is provided for each reimbursement cost.