Know About EOB Medical Billing, Medical Coding

Know About EOB


EOB or Explanation of Benefits looks like a medical bill, but actually, this statement is a notification sent to members while processing a healthcare benefits claims by an insurance company. The EOB includes information about the medical expenses, date of service, the specific codes used for billing a service and the contractual info. It also has details about the way a claim was processed. The EOB informs you about the claim fraction that has been paid to the medical care provider and the portion that you are liable for.

Adjudication Codes

Certified medical coding experts are not aware of the code sets used by third-party payers to depict payment and denial notification to medical billing experts, who take care of financial aspects of patients account and submit payments. These codes are matched to the professional domain of a medical service rather than compliance division. These codes are applied by third parties payment makers and not assigned by certified medical coders. Codes are used by insurance adjusters while processing medical claims.

CO-16 means, a claim does not include the needed information. Thus it prevents payment for a covered service. CO-45 shows the extra fee charges, N257 depicts that the third party payer does not recognize the service provider and CO-97 show that a procedure is wrapped with a previously offered and charged service. Expert medical billers identify these codes very well and adjust accounts as per the requirement. They correct the claims and resubmit them.

How EOB Helps?

Third-party payers provide information to beneficiaries about submitted claims. They notify patients about several aspects such as deductibles, co-insurance, and copays. They also offer information to patients about services that have been received and considered unnecessary by payers such as experimental or cosmetic treatment. EOB acts as an essential aspect of recognizing medical abuses and fraud.

Most patients are not able to recognize and discern the difference among codes, EOB helps them for the same. According to federal Medicare program, EOB is a great tool to detect fraud and abuses that report beneficiaries very actively on suspected factors in the claim. Healthcare beneficiaries get Medicare Summary quarterly consisting all the details about claims, submitted on their behalf. However, the advanced format of MSN is prepared in an easy to understand language so that it can be easily read by people who do not know about medical coding and HIPAA-standard adjudication codes.

Clean Claims

Expert medical billers and certified medical coding professionals work jointly to make sure that claims are submitted correctly to the third-party payers, clearly explaining the services included in the medical report of a patient. It has details about the patient like his date of birth, medical treatment, insurance identification number and other relevant information.

An EOB notifies a patient about everything included in his medical claims, its processing method and the coverage terms. In an efficient practice, all the details are applied to a patient’s record. Each code in medical business is related to a charge and an application fee. By using the info in an EOB and RA efficiently, medical billing experts ensure that a patient is liable to pay only for the services that he or she has received.