Explanation of Benefits (EOB) in Medical Billing

by | March 25, 2021 | 4:09 pm
Explanation of Benefits

An EOB is a patient-focused element of medical billing. An explanation of benefits contains details about a medical insurance claim that has been processed, payment made to the health care provider, and any payment required by the patient. EOBs are submitted by insurance companies to the patient or recipient of healthcare or therapy, with information about the payment covered by insurance and the amount owed by the patient. The EOB typically follows a bill submitted by the hospital or therapy provider to the insurance company. Patients must acquaint themselves with the EOB to avoid unpleasant surprises at the end of medical services, regarding the portion of the bill that they need to pay.

If there is a co-pay element, it is billed by the provider and should be paid to them. Some of these details are complicated. Professional billing expertise can help understand the contents of the EOB.

Significance of an EOB

EOBs are important for patients. Medical billing providers and DMEs may receive queries from confused patients because an explanation of benefits typically resembles a bill. If there is a portion of money that is co-pay or owed by the patient, an EOB will list the details, possibly contributing to confusion.

EOBs are significant to medical billing because they list charges paid and owed as well as the treatment or hospital services or therapies given. For DME/HME businesses, the EOB identifies the money owed and details of the services. As businesses try to make the medical billing process more efficient, while ensuring better risk management at reduced costs, the assistance of professional trained medical billing help is invaluable. A recent Globe Newswire report reveals a statistical estimate that more than 20% of physician’s revenue is lost due to mistakes and loopholes that occur in medical billing. This makes the case stronger for physicians and DME/HMEs to entrust the medical billing process to skilled professionals, ensuring that they streamline their operations while reducing losses in revenue.

Explanation of Benefits Infographic

EOBs contain vital patient information that can help streamline the medical billing process, including the insured ID number, details of the insurer, details of therapy availed or type of healthcare service, charges, and more. Importantly, the EOB contains details on the health plan and payment it entails, including the actual amount that is paid by the insurance for the health services received. The EOB also includes information on the total patient cost and the portion of the total owed by the patient.

An EOB can help billing personnel determine:

  • If the charges submitted in a claim are accurate.
  • Whether the claim submitted includes accurate information.
  • Whether other documentation is needed from the patient for appeals or for other reasons.

The EOB can reveal if there are errors such as incorrect provider number, which in turn can cause claims to be delayed or denied.

Your DME can thrive with professional assistance

Insurance can be a confusing matter, with a lot of documentation in complex terms and codes that are not commonplace. The technical details associated with medical billing can translate into erosion of patient trust and delayed payments.

EOBs help keep patients informed about financial obligations, co-insurance and co-pay when applicable. EOBs help identify if a particular therapy or line of treatment was prescribed but not needed, or whether patients may be paying for an unnecessary therapy. Thus, EOBs also help prevent medical billing fraud or malpractice.

Choosing a solution

A DME partnership with HIPAA-compliant services providers can help your DME practice access reliable medical billing assistance. More importantly, professional assistance can help streamline the billing process, keeping errors, payment delays, and claim denials at a minimum.

Next Steps

  • A DME partnership can provide the right assistance and expertise to reliably manage DME/HME data so the business can continue to focus on providing quality healthcare.
  • Email us at [email protected] or call 781.503.9002 for a free session.
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