How well do you know your EOB?

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How well do you know your EOB?

• EOB is an outcome of the claims process and is
  alternatively termed as a Beneficiary Notice,
  Summary of Benefits, Remittance Advisory, or
  Coverage Determination.
• EOB is NOT A BILL though it looks like one. It is
  simply an explanation of the claim covered/not
  covered by the healthcare insurers to the
  healthcare provider along with any details of the
  patient being responsible for a sum of money left
  to be paid. It is sent on a monthly basis unless
  asked otherwise (via an online platform).
• Components of an EOB
• Enrollee name This section mentions the name of
  the insurance policyholder.
• Patient name This section mentions the name of
  the patient who could be the enrollee himself or
  other family members (grouped under the
  enrollees name).
• Patient number An identification number of the
  patient.

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How well do you know your EOB?

• Enrollee address This section contains the
  address and contact number of the policyholder.
• Type of service/Products This column lists the
  services/products that the patient has made use
  of from a healthcare provider.
• HCPCS/CPT/ICD-10/Revenue codes EOB could have
  any/all of these codes as per the
  services/products rendered by the patient.
• Charge amount/Claim This section mentions the
  amount charged by the healthcare provider.
• Claim number A number in the computer system by
  which the patient and his/her claim are
  identified.
• Date and place of service The date and place on
  which the service was rendered.
• Costing/charges covered This section mentions
  the costs paid by the insurer for each service to
  the healthcare provider.

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How well do you know your EOB?

• Payment amount/Benefit amount The total amount
  paid by the insurance provider along with the
  benefits (percentage of the amount) paid.
• Ineligible amount/Reason code Along with a code,
  this column states the charges and the reasons
  due to which they have not been covered in the
  claim.
• Other insurances This section mentions the
  amount paid by an additional insurance provider.
• The amount owed by the patient In case the
  patient hasnt paid yet, then this charge is the
  patients responsibility co-insurance, copay,
  deductible, and/or non-covered services.
• Process date Date on which the insurance
  provider finalized its assessment on the claim.
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• The healthcare providers and the insurance
  providers information is also mentioned on EOB.
  The patient must ensure that he/she looks through
  the EOB thoroughly once received. Checking for
  the above-mentioned points ensures that you are
  not being billed incorrectly for a
  service/product not rendered. You are also
  informed of your copay or deductibles.

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How well do you know your EOB?
In case of any error, contact your physician or
the insurance provider to clear doubts. Keep your
EOB statements up till a year and review your EOB
carefully every time you receive it to avoid
fraud and overcharging   Medical Billers and
Coders (MBC) is a leading medical billing company
providing complete revenue cycle services. To
know more about our medical billing and coding
services, contact us at info_at_medicalbillersandcode
rs.com/888-357-3226.