tci Medicare Compliance & Reimbursement - 2018 Issue 16
Billing: Sort Out EOB FAQs with These 5 Tips
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Article Overview
This billing-focused article clarifies how explanation of benefits statements and remittance advice are used in the claims and reimbursement process. It is written for billers, coders, and practice staff who need to help patients understand payer communications and review claim adjustments and denials at a high level. The article also discusses common categories of claim-payment information, patient education approaches, and ways to monitor payer messages for workflow improvement.
Why This Topic Matters
Understanding payer statements helps practices reduce patient confusion, support clearer communication, and review claim payment activity more effectively.
Article Sections
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FAQ 1: Is an EOB a bill?
Explains the general purpose of explanation of benefits statements and how patients commonly misunderstand them. It also discusses the relationship between patient responsibility and insurer payment at a broad level.
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FAQ 2: What is the difference between an EOB and a remittance advice (RA)?
Compares the patient-facing and provider-facing versions of payer payment statements. The section notes the major distinction in how each document is presented.
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FAQ 3: What information do RAs and EOBs contain?
Summarizes the categories of information typically shown on payer payment statements, including patient details, claim activity, and benefit-related information.
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FAQ 4: How can practices help ease the confusion that patients often have about EOBs?
Describes practice-level education and communication approaches that can help patients better understand payer explanations and related documents.
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FAQ 5: How can practices utilize their RAs to streamline their processes?
Covers general ways billing teams can review payer adjustment messages, track patterns, and use payment statements for internal workflow monitoring.
What You Will Learn
- How explanation of benefits statements differ from remittance advice
- What kinds of information payer payment statements typically include
- Ways practices can help patients better understand insurer communications
- How billing staff can review adjustment and denial patterns at a high level
- How payer payment statements can support workflow review and reimbursement monitoring
Who Should Read This
- Medical billers
- Certified professional coders
- Practice managers
- Front-office staff
- Revenue cycle staff
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