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Coordination of Benefits: Reduce Payment Delays with Six Simple Steps

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Coordination of Benefits: Reduce Payment Delays with Six Simple Steps

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coordination benefits

QUESTION: We experienced an increase in Coordination of Benefits (COB) issues with Medicare last year. We finally found out there was a “glitch” in their system. The previous accident claim information was populating the primary insurance field. It took us quite a while to recover from this. What can we do to avoid issues like this in the future?

Question from Wilmington, NC subscriber

ANSWER: Every new calendar year introduces the potential for mistakes as insurers, beneficiaries, and policies are updated. Unresolved problems will increase your accounts receivable (A/R) as your claims remain unpaid. Unfortunately, it can take months to get all your claims corrected and to receive payment for those claims.

As you wait for system glitches to be resolved, prepare all the items you need for refiling so you are ready as soon as the system is. Be aware that the fix may be in process though the records aren’t updated yet; it takes several days for systems to update their records. If you check a record during this time, you may think there is still an error; but the item is in process of being fixed. After the records are corrected, resubmit the claims you already filed.

There are a variety of COB-related factors that can lead to claim payment delays or denials: unknown coverage changes, patients forgetting they have new coverage, or system errors. While you can’t do a lot to prevent system errors, the good news is that there are actions you can take to identify and prevent potential coverage issues from happening in the first place. Follow these six steps:

  1. Track COB issues by carrier/group which may help identify the problem.
  2. Run an eligibility report prior to the scheduled appointment.
  3. Be sure to ask all patients if they have secondary insurance coverage or if their coverage has recently changed.
  4. If patients present two or more cards, confirm which plan is Primary.
  5. Verify Medicare Beneficiary status to assist in identify COB or Advantage Plan status.
  6. Seek patient and/or employer involvement when necessary.

Claim payment delays and denials are financially damaging. This is where attorney, Heidi Kocher, BS, MBA, JD, CHC, can help. During her online training session “Stop Costly Penalties from Write-Off and Balanced Billing Errors,” she’ll provide you with proven tips to keep your billing compliant, legal, and as frustration-free as possible. She’ll also present all the CMS, OIG, and federal rules you are required to follow right now, along with current state specific requirements.


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Meet Your Writer

Jen Godreau
CPC, CPMA, CPEDC, COPC

Content Director

Jennifer Godreau, CPC, CPMA, CPEDC, COPC, has almost 20 years of experience in billing, coding, compliance, and practice management. She develops the content and programs for Healthcare Training Leader, a practice-specific online training company offering step-by-step advice on increasing reimbursement and avoiding compliance violations. Prior to joining Healthcare Training Leader, Jennifer supervised the program delivery for EMRs, practice management systems and compliance and revenue cycle services for more than 6,000 providers. Thousands of software products - encoders, claims management, auditing, and HIPAA compliance, have been created with her teams and helped thousands of practices more easily reduce revenue losses and comply with complex regulations. Her passion for breaking down healthcare rules and requirements in simple steps has provided practical advice, education, and risk reduction strategies to numerous associations, payers and medical specialties especially in primary care, otolaryngology, eye care, and pediatrics. Jennifer’s advocacy resulted in supervision rule revisions, new CPT codes, and CMS compliance contracts. She oversaw the provider auditing and education for one of the major corporate integrity health system settlements. Jennifer has authored and presented on numerous healthcare compliance and payment challenges. Her education guides include the Certified Otolaryngology Coder (CENTC) exam study guide and the AAPC Professional Medical Coding Curriculum. Jennifer has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She holds certificates in coding, auditing, pediatric coding, and ophthalmology billing and coding, and is AAPC Vice President of the Naples, FL chapter. Please reach out to Jennifer for step-by-step guidance at editorial@hctrainingleader.com