Tackle payment errors like a pro with this advice. Collecting payment for patients who are covered by two insurance companies can be a complicated and confusing process. When you also think about differing payer claims processes and the fact that patients might not give you all the information you need, your head can start to spin. You can maximize your practice's reimbursement and reduce the costs of administering claims for patients covered by more than one payer if you understand coordination of benefits (COB) and how both insurers are supposed to pay. In the first article of this two-part series, "Overcome Primary vs. Secondary Payer Woes with Answers to Your FAQs" in the Volume 4, Number 6 issue of Podiatry Coding and Billing Alert, you got answers to the first three frequently asked questions about primary and secondary payers. You learned what coordination of benefits (COB) means, how state law affects COB, and how to tell which payer is primary. Now, in Part 2, read the final two FAQs and the experts' answers to learn who is responsible for knowing which payer is primary and also how to handle payment errors caused by dual coverage. 4. Who Is Responsible For Knowing About Primary vs. Secondary? There is no exact, easy answer to this question, but everyone should be aware of which insurance that patient has. "Ideally, the patient should know but that is not usually the case," says Linda Huckaby, CMA (AAMA), with Carolina Medical Rehabilitation in Greenville, S.C. "Everyone, provider, patient, and payer, has a responsibility to know," says coding, billing, and practice management consultant Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS, in Orlando, Fla. "The provider should know because they need to know who the claim is to be sent if the patient has covered health benefits. The medical biller who works for the provider should know for the same reason. The patient should know so that they seek care from doctors who are networked with their insurance plans, which may be outlined in their contract with the insurance company." Your practice should be asking the patient for his insurance information before rendering services. Be sure to ask the patient if he has more than one plan. "It is the responsibility of the practice to identify primary and secondary because billing done incorrectly slows the revenue flow," Huckaby adds. "The payer will always have some clue as to primary and secondary, although sometimes that information is incorrect and requires assistance from the patient." Best bet: If your practice verifies eligibility and benefits prior to an appointment, sometimes the insurance companies will indicate that other insurance coverage exists. That would let you know ahead of time that you should speak to the parent regarding the primary/secondary coverage. Work faster: Ask the patient: 5. What Does the Secondary Pay? The secondary plan must determine the amount of benefits it would normally pay if no coordination existed and apply that amount to unpaid covered charges owed by the insured after any benefits have been paid by the primary payer. The payable amount must include deductibles coinsurance and copays owed by the insured. The secondary plan can use its own deductibles coinsurance and copays to determine the amount it would have paid had it been primary. It can apply only its own deductibles coinsurance and copays to the total allowable expenses not to the amount owed after payment by any primary plan. The secondary plan has no obligation to pay for any services that it does not cover as a benefit. A practice should never expect reimbursement from the primary and secondary insurer to total more than the service charges. COB's purpose is to make sure insurance payments for patients with duplicate health insurance coverage do not exceed the cost of the services. When a secondary insurer acts on your claim, check the payer's COB clause to see if it followed its own rules. Ask the insurer's customer-service representative to explain its COB rules and request a copy in writing. A company's Web site may also offer COB handling explanations. Or ask patients for copies of their insurance policies. 6. How Should I Handle Payment Errors We Discover? You are obligated to refund overpayments to payers regardless of primary-versus-secondary issues between the payers. "Keeping an overpayment might be deemed to be fraud or a possible kickback" Verno warns. Stay compliant: If you discover an overpayment, your practice should be prepared to refund one of the payers -- or sometimes the patient -- the money due. Example: Pointer: If a patient presents you with information on what she thinks is her primary insurance, and your practice finds out much later that it was her secondary insurance but you were paid, talk with the payer. Ideally: Reality: Be proactive: "Contact should be made with the overpaying insurance, first, to identify what happened to create the overpayment; then a refund should be initiated as per instructions from the insurance company," Huckaby explains.