Explanation of benefits. plz explain this in detail.

by Faraz Ali Khhan
(Delhi, India)

I just need to clear my thoughts regarding explanation of benefits (EOB). Sorry to say but I have not yet cleared this so plz will you explain this.



Thanks!
Faraz

Thanks for the question Faraz - here's my attempt to answer and explain the Explanation of Benefits:

If a patient has medical insurance, the doctor's office submits a claim to the patients insurance company for the visit to the doctor. This contains the ICD-9 diagnosis and CPT treatment codes for the procedures performed by the doctor.

The Explanation of Benefits (or EOB) is a form or report that provides details and results of the insurance companies processing of the claim. It is provided to the doctor with insurance company payment and contains information about the claim such as:

  • Patient name and policy number.

  • Date of visit - called the Service Date

  • Amount charged by the doctor for servic.es provided.

  • Amount not covered by insurance - sometimes referred to as "Write-Off".

  • Amount allowed by the patients policy.

  • Copay and Deductible - this is the amount the patient has to pay based on their policy.

  • Any remark codes or special explanations regarding payment.


The EOB may also includes information on the patients year-to-date status with regard to deductibles and out-of-pocket costs.

As a medical biller, we use the information from the EOB to enter into the practice management software that keeps up with payment information. If there is any remaining uncovered amount due, a statement is generated and mailed to the patient.

Hope this helps clear up any questions you have on EOB's.

Thanks for the question,

Gina

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. Is it possible to work in Medical Billing or Coding at night instead of during the day?

    Oct 23, 17 09:16 PM

    How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I'm an

    Read More

  2. Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

    Oct 23, 17 09:15 PM

    Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

    Read More

  3. What is the CPT code for 'Male Hormone Panel'

    Oct 23, 17 08:57 PM

    What is the CPT code for 'Male Hormone Panel' ...testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We'll post in hopes our Visitors

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2017 All-Things-Medical-Billing.com