Professionals in the Healthcare and Hospital Revenue Cycle industry have seen significant changes the last few years, especially when it comes to patient coverage (i.e. insurance coverage, federally funded programs and other benefits.) To begin combating the complexity of it all, your facility has probably already introduced the process of Coordination of Benefits (COB). COB is relatively self-explanatory in its definition; however, effectively performing the function has proven to be quite a bit more involved when the patient doesn’t comply with what is needed from them.
When payment is denied by Medicaid or Medicare, because there is a belief of existing coverage, that account can quickly become a self-pay account if the appropriate forms are not successfully completed. As a self-pay eligibility vendor, RCA has a vested interest in helping our clients recover those dollars. RCA already performs rigorous account follow-up and has existing resources that are complimentary to an effective COB solution.
Worked much like a self-pay referral, the COB account will require completion of a necessary form and then actively pursued until resolution. COB services include identifying an accurate payer, initiating billing and securing payment. Additionally, our representatives will coordinate phone calls between the patient and insurance company and will conduct home visits to ensure that the information that is needed to pay the claim is collected and sent to the insurance company. After the information has been submitted, we continue follow up with the insurance company until payment to ensure that the insurance company does not need any additional information from the patient.
Coordination of Benefits has become increasingly popular with insurance and software companies and their methods are very effective on the low risk cases; however, if an account is non-compliant for more than 30 days, you may want to consider CACOBV, “Coordinating another COB Vendor.”