How to read an EOB | Medical Billers Edition Volume 1
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- Опубліковано 28 гру 2021
- Are you confused about how to read EOBs (explanation of benefits) or just curious about what one looks like? In today's video, we are delivering a request from Keisha in our community, who asked for a quick tutorial summarizing how to read an EOB as a medical biller
❓❓ Do you have a question about the revenue cycle or the business of healthcare? Drop your question below!
#eob #medicalbiller #howtoreadaneob
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Who is Jasmine?
Jasmine Vializ is the Founder of IPS Learning Institute. IPS Learning Institute is an education firm committed to enhancing the delivery of healthcare by providing quality training to the business side of healthcare.
Jasmine Vializ is a healthcare advisor, speaker, and leader. Jasmine uses her passion for people and two decades of healthcare leadership experience to usher in the next generation of medical billers and take organizations to new levels of efficiency and effectiveness. She is highly skilled at developing systems positioning an organization to scale while delivering exceptional services to its clients and patients. As a result, during 16 years of owning her medical billing & credentialing firm, her clients experienced an average of 20% in growth during the first six months of working with her organization. Jasmine operates from her core mission to improve the delivery of patient care by alleviating the stress and confusion from the business side of healthcare.
Who is Rene?
Rene Lumene is an accomplished healthcare operation leader with a diverse professional background. A highly accomplished health care executive with over 16 years experience and has the ability to balance strategic decisions and financial discipline with a hands-on approach to leadership-resulting in strong employee, patient, and physician satisfaction. Engaging communicator and relationship builder with expertise in organizational planning, multimillion-dollar operational budget, contract negotiations, consulting, team development, and increasing visibility for growth.
Rene is a graduate of Webster University and double Masters’ major in Business Administration and Healthcare Administration. He completed his undergraduate study at Bellevue University to earn a Bachelor’s in Healthcare Management. An entrepreneur at heart and an inspiring leader in life and in business. His experience working at major healthcare organizations, military including local healthcare systems, has allowed Rene to experience healthcare from all spectrums.
i love you jasmine❤❤❤❤thanks for the explanation
Great effort of training Jasmine. I also learnt EOB today.. Thank you🙂🙂☺☺
Such kind words. You're welcome! Always happy to help people learn :)
Wow Great Job 👌👏
Thanks a lot 😊
Hi! Love your videos for their exceptional clarity! Could you please make one on payment posting? Thanx
Hi, thanks so much for the feedback! I will definitely add that to our list of ideas, keep an eye out for it in a future video!
Thanks for the video
Thank you for watching!
This so helpful thank you
Yay!!! SO Glad to hear it was helpful! I will be releasing more on this topic in the coming days. And the font size will be better :)
I absolutely hate that every payor EOB is different 😫 it makes coordination of benefits so difficult!
Ugh tell me about it!! & for this reason, I need to do more example videos. Seeing more you will eventually get to know the different variations but, yes, it is a pain!
Thanks for your explanation! CPT 27866 is for Amputation (leg) allowed amount is 76.70 that's very surprising.
You're welcome! Yes, it can be surprising to find out the allowed amounts, but that's part of the fun isn't it!
Thank you for the video! Could you please make one that has how much co-ins, ded etc instead of zero?
Yes!!! I will have it up in the next couple of week. I appreciate your comments :-)
If you think about it you need insurance only in countries where costs of providers are sky high. In many countries you don’t need insurance because providers have honest prices. You pay the fair amount and you go home and that’s it, you will not receive anything to pay by mail once you leave the specialist’s office.
When you said over 20 years of experience I was so baffled because you look about 25. I love your channel and will be scouring it for more videos !!! Thank you for sharing your wealth of knowledge in such a concise way!❤
Haha, thank you so much for the compliments! Glad to hear you’re appreciating the content :)
If you are looking for anything specific or have any questions, let us know!
HI, Jasmine, thanks for making such an informative video, I have a question: You have mentioned the provider's responsibility, how it would happen that a provider will agree to pay his responsibility happily. however, the provider will cure the biller and reject his contract. what do you think?
It would have been helpful to have actual copay / co-ins / and reason codes reviewed. Maybe a more detailed EOB for this training?
Thank you for your feedback! I will absolutely take this into consideration for the next one!
I worked ER registration for 22 years and decided to work in billing as a insurance follow-up and denials. I understand how to get things answered but when it comes to adjustment I tense up because I don't get it. 😬 I don't understand what order to calculate so I Can make an adjustment. I almost want to quit because it makes me feel so stupid. Managers explain to intensely and I'm an analytical thinker and they think fast. I just don't get if we do an adjustment to the ins company. I need to know the step by step instructions on how I should arrive at my adjustment. Also crowns and puppets help
Are you still working there? If so I can give you some tips. If not, I don’t want to type a huge paragraph in detail for no reason lol
Oh no! So sorry, just seeing your comment. How is it going?
It sounds to me like you are doing some payment posting? Perhaps a job where you are only doing higher level appeals or disputes would satify the analytical thinker in you. Due to volume, most billers are expected to be quite quick decision makers. Coding research and appeals move a bit more slowly and require more in depth analysis.
See my reply below. Does that help you?
@@SheaButterBallin I'm from India working as AR follow-up and find difficult to work on denials could u help me out please., if u dont mind
@@AmbikaBharath I’d love to help! What part is difficult? A denial is the payer deciding not to pay the claim. The gist is there are different types of denials. You can find the reason by looking at the EOB(Explanation of Benefits), calling the payer, or logging onto a portal such as Availity to get the reason they denied. Then most times you may be able to send an APPEAL. Which is you telling the payer that you don’t agree with their denial and providing documentation why you are right in saying the claim should be paid.
A common denial reason I saw was insufficient medical records. In which case, I would gather up all available records(will vary depending on what the speciality is.) And send it over to the Payer along with a letter…usually a template from my company that’ll say “please reconsider blah blah” and letting them know how much the provider should receive based on the contracted rate of pay. Some payers prefer you mail, fax, or upload appeal to their portal. I hope that helps. Let me know of you have more questions.
My wife always has me look up our medical insurance EOB online to see if it's been updated and see if we owe anything. My question is: our med ins. gives us a discount on the total amount and puts the amount we owe at the far column. Why do some medical facilities still send out a bill for the discount when our EOB says "Patient Responsibility" = $0.00?
In the video you state you will have more examples, where can I find those videos?
Thanks for your question! We took a little break from creating videos but now we are back and you will see some additional examples in the next couple of weeks.
I've worked in Healthcare for the past 20yrs in various types of positions and I'm trying to get a job as a Claims Analyst. what type of training do you recommend?
Thanks for your question. I think I need to understand more about the "claim analyst" position first. Is this on the insurance side or provider/organization side?
Hey. Can you make a videos on FQHC Medical Billing and how does it work. And how different it is from other Billing?
Thanks.
Thanks so much for your comment! Yes, I am working on FQHC related content now. Let me know what other specific questions you have so I can make sure that we cover them in future videos.
Can you please show tutorial how to read Medicare RA?
Thanks so much for the feedback! I will definitely add that to our list of ideas, keep an eye out for it in a future video!
Where can the provider can get the EOB? I thought that the patient only has the ability to receive or access the EOB?
The provider would need to reach out to the carrier for access to the insurance online web portal. The common term used for payments made to patients is EOB and we use it for the payment to providers too but the proper term is Remittance Advice.
Is EOB applicable for homemaker service and home health aide?
If you are billing commercialy or federral insurance carriers then yes it would be applicable.
How to pulled out eob from the insurance company online plz help
That can be tricky, it does depend on the program being used, and sometimes the insurance company. Would you be able to provide a little bit more information?
So who pays for the difference for the amount of the procedure and the allowable amount?
Thank you for your comment! If you are in network, that amount is adjust it off according to your contract. If you are not a network, then you are able to bill the remainder to your patient. However, you’re going to want to have communicated in advance, the fact that you were not in that work to prevent any issues with surprise billing.
Co pays confused about them. My EOB said 0.00 for co-pays but the allowance is 103. what does this means
Allowance is what they allow for payment/deductible/copay in the contract. So if there is no co-pay or deductible then the allowance should be the full payment they give you.
It means you do not owe for the copay and as long as there is no deductible you do not owe for that visit and if you paid you should reach out to the provider to see if you have a credit and can get a refund.
What is Garnishment???
Garnishment is typically an amount being taken due to a court order.
Can you provide us the word languages in Our Career?
Hi Sarah, can you elaborate on what you mean by that?
Is there a REASON CODE TABLE?
You can Google it. That's what I do.
Yes, if it is electronic & coming in an ANSI standard format they come from a nationally published resource that can be found here: x12.org/codes/claim-adjustment-reason-codes
what is the meaning of finalized-the claim/encounter has completed the adjudication cycle no more action will be taken
The claim has been studied so whatever the decisions of the insurance company on how much they are going to pay the providers then, that's it.
Hmm well it mean they have completed processing of the claim.
Hmm I am not following your comment. Please try to re-explain.
So is this saying that the patient pays the $611.22?
Thank you for your comment! No, this is stating that the insurance is reimbursing that amount. In that particular example, there is no patient responsibility.
I want to work as a Medical biller can I work for you
Unfortunately we don't have any positions open at the moment, but the Medical Billers Network facebook page is a wonderful place to network ❤️
We also have a playlist for advice on getting hired:
ua-cam.com/play/PLgzxQ8JwGid-jYzvpCOVNShKqVSV7aaqT.html&si=4ickK6ADCDFvErjS
Best of luck!
I want to work and learn even if you give me tasks ill be happy to work on. Its because i want to learn the whole RCM.I can work for free for first 2 Months@@InleraU
Can I call you through WhatsApp... Regarding iv
Hello & thank you for your comment. What did you need help with?
I hate all these health insurance companies tbh
They can be difficult sometimes for sure!