Manage Coordination of Benefits (COB) Denials-converted

1. MANAGE COORDINATION OF BENEFITS (COB) DENIALS MEDICAL BILLERS AND CODERS

2. Centers for Medicare & Medicaid Services (CMS) defines coordination of benefits (COB), as the process which allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities. In simpler words, COB determines which insurance carrier is primary, secondary, and so forth. This coordination between insurance carriers exists to avoid duplicate payment, which could result in a provider receiving payment in excess of the services provided and the total amount billed. Receiving denials due to the coordination of benefits issues is quite common. Whether you are a patient, provider, or billing staff, you surely came across coordination of benefits denial at some point.

3. Coordination of Benefits and Medicare Many patients have Medicare, so it stands to reason that this issue is most commonly seen when dealing with Medicare claims. Medicare-eligible patients may also have a Medicare supplemental plan, such as AARP, as their secondary. In most cases, information on file and will automatically cross the claim over to the supplemental insurance. However, this process is not foolproof. Therefore, it is important that the provider documents all insurances for the patient. In the event that Medicare does not cross over the claim, providers will need to manually submit claims to the patient’s secondary. Medicare will have this

4. COB and Other Insurance Carriers ▪ There are several situations in which it is necessary to understand the coordination of benefits. These include, but are not limited to: ▪ Unless otherwise specified, insurance plan should be primary, while their spouse’s health plan would then be secondary. This can be especially complicated when both have their insurance under the same carrier. ▪ If the services rendered are due to an accident, the patient’s workers’ compensation insurance would be used commercial insurance would be billed second. ▪ If patients have both Medicaid commercial insurance, Medicaid will always be used last. the employer patient’s or motor vehicle as primary, while the and any type of

5. Medical Billers and Coders: Quick Payment with Coordination of Benefits Coordination of benefits can be a complicated process and it is not always clear which insurance is primary. It is always a good idea for patients to verify the order of their policies before scheduling precautionary step will reduce the risk of claims getting denied for a COB issue and save time in the long run. In addition, if the COB needs to be updated, this can often take a week or more to finalize. Staying one step ahead of easily corrected insurance issues means fewer headaches for providers as well as for patients. an appointment. This

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