Interpreting EOB and Payment Posting

1
Interpreting EOB and Payment Posting

• Preposting operations
• Compare the EOB with the original claim and
  review each
• Determine the reason for all denied services and
  appeal them, if approp.
• Address all insurance company requests for
  additional info.

2

• Post EOB information on ledger card or computer
  promptly
• After posting the EOB, file with insurance claim
  form

3

• Contractual adjustments the difference between
  what a practice bills and what it is legally
  entitled to collect.
• If normal fee is 1,200 and contract
  reimbursement is 1,000, the contractual
  adjustment is 200

4

• Withhold adjustments an amount withheld from a
  physicians reimbursement that may or may not be
  reimbursed, depending on the managed care plan

5

• Normal charge 1,000
• Contract will reimburse 800
• Could withhold 10 or 80
• Physician would receive 720

6

• Fractional payment of allowed charge insurance
  company usually pays only a fraction of the
  allowed charges patient is responsible for the
  balance (co-insurance)