Coordination of Benefits (COB) is a crucial aspect of revenue cycle management. With patients often having multiple insurance policies, ensuring that each policy pays its share is vital. Here's how AI-powered COB curation solutions can make a difference.
The Coordination Of Benefits Challenge
Coordination of Benefits is a pivotal aspect of RCM, but it's not without its hurdles. Here's a look at the complexities that often arise:
- Overlapping Policies: Determining which policy pays first can be confusing. Patients with dual coverage might not always be aware of the hierarchy, leading to billing complications. And many legacy systems only select the primary, without consideration for secondary or tertiary. And regional plans add another layer of complexity.
- Claim Denials: Incorrect COB can lead to claim denials or overpayments. This not only affects revenue but also strains the patient-provider relationship when patients are billed incorrectly. No one likes an angry patient (especially the angry patient).
- Administrative Burden: Manual COB verification is time-consuming and prone to errors. Staff often spend hours cross-referencing policies, which could be better spent on patient care. Putting FTEs on COB is a cost overrun waiting to happen.
Wave HDC AI-Powered COB Solutions
To address these COB challenges, AI-powered RCM software solutions offer a range of benefits that can simplify and optimize the process:
- Instant Verification: AI can instantly determine the primary and secondary payers. This means hospitals no longer need to rely on patients' knowledge of their insurance hierarchy, ensuring that claims are submitted correctly the first time.
- Automated Claim Submission: The software can automatically submit claims to the right insurance, reducing denials. This not only speeds up the reimbursement process but also ensures that claims are submitted with all the necessary information.
- Reduced Administrative Work: Automation means less manual work, freeing up staff for other tasks. This leads to increased efficiency, allowing staff to focus on more critical tasks like patient care.
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