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Demystifying Coordination of Benefits: What Therapists Need to Know

Demystifying Coordination of Benefits

As a therapist in private practice, navigating the complexities of insurance billing can be daunting. One key aspect that often confuses providers is Coordination of Benefits (COB). COB comes into play when multiple insurance plans cover a patient. Understanding how COB works is crucial for ensuring smooth billing processes and maximizing reimbursements. Here's what you need to know:

What is Coordination of Benefits?

  • Coordination of Benefits (COB) is a process insurance companies use to determine the primary and secondary payer when two or more insurance plans cover a patient. The primary insurance pays its share of the claim first, and the secondary insurance covers some, all, or none of the remaining costs up to the total amount of the bill.

How Does COB Work?

  • When a patient has multiple insurance plans, one is designated as the primary payer and the other as a secondary payer based on the birthday rule

  • The primary insurer processes the claim first and pays according to its policy.

  • The secondary insurer then processes the claim, considering what the primary insurer has already paid, and covers the remaining costs, if applicable.

The Negative Impact of Incorrect COB

What happens if your client fails to submit their COB information? There are negative consequences that insurance companies impose on providers and practices in the event the client does not update their COB. Here are a few impacts to your revenue that you might experience: 

  • Delayed Payments: Incorrect COB information can lead to delays in payments from insurance companies, affecting your practice's cash flow.

  • Underpayments: If COB is done incorrectly, you may receive lower payments than you are entitled to, which can result in lost revenue for your practice.

  • Billing Errors: Incorrect COB information can result in billing errors, which can lead to claim rejections and additional administrative work for your practice.

Actionable Steps for Therapists

Now that you understand the basics of COB, here are some actionable steps you can take to streamline the billing process:

  1. Verify Insurance Information: Always verify your patients' insurance coverage, including whether they have multiple insurance plans. Your biller can sometimes tell when your client has another insurance plan, but only sometimes. It is a best practice to ask your clients to inform you if anything has changed since their last visit.  

  2. Collect COB Information: Obtain detailed information about each insurance plan, including policy numbers, group numbers, and insurance company contact information.

  3. Submit Claims Correctly: When submitting claims, indicate the primary insurance information first, followed by the secondary insurance information.

  4. Follow-up: After submitting a claim, follow up with both insurance companies to ensure they process the claim correctly and pay their share.

  5. Talk to your Patients: Reminding your clients to contact their insurance company or companies is an excellent way to make sure you are on the same page with the insurance company. 

Helpful Tips for Patients

Patients can also play a role in ensuring smooth COB processes. Here are some tips to share with your patients:

  1. Provide Complete Information: Patients should provide accurate and complete insurance information, including all insurance plans they are covered by.

  2. Understand Coverage: Patients should understand their insurance coverage, including which plan is primary and which is secondary.

  3. Keep Records: Patients should keep records of all interactions with their insurance companies, including claim submissions and payments received.

  4. Check the App: Insurance companies often have apps that patients can download to view claims, prescriptions, deductible accumulations, and other coverage information. Some insurance companies allow patients to update their COB information within the app. You can have your clients update their COB information on the app during or before a session. 

Contact Practice Solutions for Hassle-Free COB Management

Managing COB can be complex, but with the proper support, you can streamline the process and maximize reimbursements. Practice Solutions offers comprehensive insurance billing services, including COB management. Contact us today to learn how we can simplify your billing processes and help you focus on providing exceptional patient care.

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