Understanding EOB's
Master Your Understanding of EOBs
Are you confused about Explanation of Benefits (EOB)? This quiz will help clarify the components and terminology of EOBs, making it easier for you to understand your health insurance claims. Test your knowledge and discover how to interpret EOB documents effectively!
- Learn about key terms like Allowable Amount and Contracted Fees.
- Test your understanding of insurance processes.
- Improve your financial literacy when it comes to healthcare.
What are four items you can find on a HEADER?
Check number,coverage percentage,maximum remaining,ada codes
Check number,patient name,insurance company,provider TIN
Check number, insurance phone number, date of service,ada codes
Check number, office NPI, total amount paid, date of service
What are four items you may find in the EXPLANATION?
Date of service, coverage percentage ,ADA codes, reason codes
Date of service,Insurance Address, Insurance Name, Provider TIN
Date of service, phone number for questions,home address for patient, past due balance
Date of service, check number, patient DOB, insurance name
What are four things the SUMMARY will provide?
Definitions and Restrictions on codes
Ways to contact insurance company with appeal or questions
Total for claim amount
Maximum and Deductible remaining
What is a Submitted Fee?
Charges from the insurance company
Balance owed by patient
Actual charges your office intends to charge and collect for treatment
Contracted amount
What is a Contracted/Negotiated Fee?
Our office fee
Total percentage covered
To know if your IN or OON and if any network adjustments are to be given
To know if your office accepts the insurance
What is the Allowable amount?
The amount the insurance pays the office
The amount the insurance company will process their portion off of
The amount the patient will owe
The amount the insurance company keeps for themselves
What is a Copay/CoInsurance/Patient Portion?
Patients out of pocket cost
Patients already paid balance
Patients $5 per visit balance
Patients writeoff
What is an Ineligible amount?
Everything under the ineligible amount is covered at 100%
One that is used and no matter if we agree with the term, we must follow the rules
Our charge to the patient
A write off
A Non-covered service means we must offer a discounted contracted rate to the patient?
True
False
An inclusive code has certain RULES we as the providers office must follow no matter if we agree or not?
True
False
We must always work rejections
True
False
With an Out of Network claim we can charge our standard fee, leaving the patient with the remaining balance
True
False
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