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" Practices can maximize reimbursement and reduce the costs of administering claims for patients covered by more than one insurer -- such as those whose employers and spouse's employers both provide health benefits -- if they understand coordination of benefits (COB) and how both insurers are supposed to pay, says Felecia Bernstein, CPC, EMT, a coding and reimbursement consultant in Deal, N.J. COB is a common clause in most health insurance policies. It specifies how the insurer will reimburse for services when more than one insurance plan is applied to a claim. Although COB rules can be governed by state law, and most insurers have COB rules in their contracts, many payers follow model rules developed by the National Association of Insurance Commissioners (NAIC), says Steve Verno, CMBSI, NREMPT, practice manager with Emergency Medicine Specialists, a 23-physician practice in North Miami Beach, Fla. Under the rules, the plan that pays first is known as the primary plan; the one that pays second is known as the secondary plan. The primary plan must pay benefits as if the secondary insurer did not exist. The secondary plan can only take into account what another plan paid when it is secondary to that plan. Commercial insurance is generally primary to any public insurance program, such as Medicare and Medicaid, but there are exceptions. For example, federal law states Medicare is the secondary payer when no-fault or liability insurance is available as the primary payer, as in auto accidents. This rule applies even when state law or the insurance policy states that its benefits are secondary to Medicare or otherwise limits payments if the injured person is also entitled to Medicare benefits. Medicare is secondary to employer group health plans under federal law. Medicare beneficiaries age 65 and older who have group health-plan coverage because their spouses are working have Medicare as their secondary payer. When a provider has a contract with an insurer" the provider must adhere to the terms of the contract and those terms can vary Verno says. A contract may contain COB rules that are different from NAIC rules. Read your contracts on COB and contact the insurer if you have questions. To ensure your practice collects all the reimbursement it deserves when a patient has primary and secondary insurers it is essential that you obtain the correct health insurance information from the patients Bernstein says. Your front-office staff should ask for insurance information at every patient visit. You could also ask the patient for a copy of each policy Verno says. If a patient reports two insurers verify the coverage and which is primary and which is secondary with both. Getting the correct insurance information can help you submit claims to the payers correctly …….. For more read:-
http://www.supercoder.com/articles/articles-alerts/mob/best-ways-to-coordinate-benefits-from-multiple-insurers/
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