Outpatient Facility Coding Alert - 2017 Issue 7
Reader Question: Be Ready to Answer EOB Questions
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Article Overview
This reader question and answer article addresses a common front-office and patient communication issue in medical practices: helping patients understand explanation of benefits statements and distinguishing them from actual bills. It is relevant to billing staff, patient account representatives, and medical insurance specialists who handle claim follow-up and patient inquiries. The article offers general guidance on how these calls are typically managed and when to route questions for additional payer-related assistance.
Why This Topic Matters
Patients often confuse an explanation of benefits with a bill, and practices need a clear, consistent way to respond. Understanding the broad purpose of the EOB and the roles involved in follow-up can improve patient communication and reduce confusion.
What You Will Learn
- How practices can respond when a patient calls about an explanation of benefits statement.
- Why patients may confuse an explanation of benefits with a bill.
- What general types of follow-up may be needed when a patient has questions about claim payment or an outstanding balance.
- When it may be appropriate to route an EOB inquiry to a medical insurance specialist.
Who Should Read This
- Medical billing staff
- Patient account representatives
- Front office staff
- Medical insurance specialists
- Practice managers
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