There are three major components/members of the healthcare industry, including the healthcare provider, the patient getting the medical treatments done and the insurance taking care of the payments. For the entire system to run smoothly, there is a need for each of these parties to be systematic and coherent in their activities. If even a single party showcases incompetency, it may end up affecting the entire system negatively. A major role played in the working of this network and turning it into a great success is the AOB, also known as the Assignment of Benefits in medical billing.
This article will walk you through everything associated with the assignment of benefits in medical billing, what it entails, and what elements should be a part of it.
Assignment of Benefits
It won’t be wrong to say that assignment of benefits is one of the most crucial documents that are a part of the healthcare system. In simple words, the assignment of benefits refers to an agreement that transfers the insurance claim related to healthcare and the benefits associated with the policy chosen by the patient to the medical practitioner or healthcare provider. This document leads to the transfer of payment to the healthcare provider against all the benefits offered to the patient. Hence, once this document is signed by the patient, the insurance payer is bound to reimburse the medical practitioner.
In the absence of the AOB, it would be the sole responsibility of the patient to pay the cost of medical services taken from the medical practitioner and then file the claim to the insurance company to make timely reimbursement.
Elements of The Assignment of Benefits
Being a crucial document, AOB has to be created keeping in mind the intricacy associated with it. Though it’s a legal document, it comes in various formats as each medical officer or his team may be following a different pattern or format while creating this document.
Patients sign the form allowing the insurance company to let out the relevant information required by the medical caregiver for reimbursement purposes. Hence, once this document is signed by the patient, he indirectly gives the authority to the insurance company to give away the required information and data to the medical practitioners.
At the same time, the signatures also confirm that the patient has concurred to nominate someone from the medical practitioner’s staff to seek the required payments from the insurance company in the agreement.
Creates A Communication Channel
This document also relieves the patients from the requirement to connect with the insurance company or the medical practitioner directly for payment reasons. Once he authorizes both parties to communicate with each other and continue with the following activities, he can come out of it and doesn’t have the liability to connect with them himself.
Transfer Of The Liability To Pay
Upon successful completion of the claim process with the insurance company/payer, the assignment of benefits occurs. This is the exact time when the patient transfers the liability of payment making to the insurance company. For medical practitioners finding it tough to manage the billings, outsourced billing services can be hired.
However, at the same time, there is a need to mention that the insurance company, connected with the particular process, may not accept the AOB request. There may be a rejection for various reasons, and most include the patient’s health benefits contract clauses or the State Law.
Connected To The State Laws
This is why all three parties to the process, the medical practitioner, the patient, and the insurance company must stay updated with the changing state laws. Even a modification of a single clause can lead to extensive problems when it comes to the reimbursement of insurance amounts.
Staying updated with the changing state laws and rules is necessary as it doesn’t only aid in saving time but also helps in reducing the paperwork. A review of the health benefit plan of each patient is a must for the medical care provider to ensure the claim is not rejected later on.
Various factors play their role in the working of AOB and turning it into a success. These include the insurance policy taken up by the patient, laws of the state, and the kind of medical procedures offered by the health care provider. By signing the AOB, the patient surrenders his right to negotiate with the insurance company regarding the provider’s services.
What Should Be In An AOB?
As a single signature creates a legal relationship between the three parties, there is a need to compose the AOB with great precision. An appropriate assignment of benefits includes the following elements:
Exact Name Of The Business
Even a minor mistake in the name of the business that requires reimbursement can lead to blocking the entire process and creating unnecessary delays. For that matter, there is a need to showcase the highest level of perfection while adding the name of the business entity in the assignment of benefits while creating the medical billing documents. Even if an Outsourced medical billing services company is involved in the process, it has to make sure that the name used in the contract is accurate.
The Term ‘Irrevocable’
The term irrevocable is really important and holds great significance in contracts that create legal obligations. This term means that the patient can’t revoke the assignment of benefits later on.
Showcase Of Rights
Showing rights in this contract tells the court to check out the payments, used as benefits, on behalf of the patient to the medical practitioner. These rights are assigned to the insurance company which will then pay the medical health provider.
Benefits Of Non-Payment While Getting Treated
In exchange for the right to sue the insurance company if they are not paid in full, a provider gives up the right to collect payments at the time of service. The patient will give up their right to sue, but will not be required to pay.
Authentic Signature By The Patients
This is probably the most important part of the contract. The patient has to put up his accurate signatures to make this piece of paper a legal entity creating rights and duties.
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Frequently Asked Questions
The assignment of benefits refers to an agreement that transfers the insurance claim and associated benefits from the patient to the medical practitioner or healthcare provider. It allows the medical practitioner to receive reimbursement directly from the insurance payer.
The assignment of benefits simplifies the payment process by shifting the responsibility of payment from the patient to the healthcare provider. It ensures that the medical practitioner receives timely reimbursement from the insurance company.
An assignment of benefits document should include the exact name of the healthcare provider or business entity, the term “irrevocable” to indicate the patient cannot revoke the assignment, a clear showcase of rights assigned to the insurance company for payment, and an authentic signature by the patient to validate the contract.
The assignment of benefits allows authorized communication between the medical practitioner and the insurance company for payment reasons. This relieves the patient from the direct responsibility of connecting with both parties regarding payment matters.
Upon successful claim processing, the assignment of benefits takes effect, transferring the liability of payment from the patient to the insurance company. This allows the medical practitioner to receive payment directly from the insurance company.