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Understanding EOB's

A detailed illustration showing an Explanation of Benefits (EOB) document with highlighted sections like summary, charges, and insurance details in a visually engaging style.

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.

13 Questions3 MinutesCreated by DecodingHealth101

What is an EOB?

Explanation of how a claim was paid.

A bill

A summary of coverage

Explanation of bills

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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