Coordination of Benefits and COVID-19 testing

WCH Service Bureau has been working hard on keeping you on the same page with all the relevant regulations and issues that may affect your practice in some ways. Here are the two most popular questions that we had received from our clients in November:

Question: What is Coordination of Benefits and how does it affect my billing flow?

Answered by Arslan Suleymanov, medical reimbursement specialist, and editor-in-chief of WCH Insights

Insurance coverage information is often confusing. Some of your patients may have coverage with up to 4 insurances or benefit plans. As a result, you may find yourself bewildered and do not know which payer to submit a claim for your services to. To put it simply, you are not sure which insurance is supposed to pay for your services. No need to worry – every healthcare provider has encountered such cases at some point. Coordination of benefits (COB) is an individual rule that determines which payer is primary and which one is secondary. By “primary” I mean a plan that pays for the service itself. However, a “secondary” payer is the one covering all the remaining expenses after a primary plan payment. There may also be a “tertiary” payer – insurance that covers the remaining balance after both a primary and a secondary payer have made their contribution.

How to accurately determine a patient’s COB?

Coordination of benefits must be discovered upon an eligibility verification process. Whether you check your patient’s eligibility online or via phone call to customer service, there is always an option to inquire if a certain payer is primary during the process.

Can there be a discrepancy between the payers?

Yes, unfortunately, insurances and various benefit plans often do not have accurate information in their records. A primary payer may be “considering” itself a secondary, and vice versa. Such cases are always “fixable” – a patient would just need to contact the payer and ask the customer service to update their coverage information.
Proper COB verification is critical for your claims to be paid promptly. By the way, our eligibility software allows you to check the validity of a patient’s insurance coverage and its coordination of benefits.

Question: How to properly report COVID-19 testing?