Billing Basics
What does “EOB” stand for in medical billing?
Explanation of Benefits
What is a “deductible”?
The amount a patient pays before insurance starts covering costs
What does EOB stand for?
Explanation of Benefits
Copay: $25, visit done
Client pays $25
In billing, what does “POS” mean?
Place of Service.
What is a copay?
Fixed amount paid per visit
What is the 'adjustment'?
Amount the provider agrees to write off
Deductible not met—who pays?
Client pays full allowed amount
Who is responsible for billing patient co-pays?
the provider
What is coinsurance?
Percentage you pay after deductible
What does 'allowed amount' mean?
What insurance agrees to pay
EOB says 'Patient owes $15.44' – why?
It’s their responsibility (copay/coinsurance)
when do you post a payment?
after insurance send payment or EOB
Define “out-of-pocket maximum.
The most a patient pays in a year before insurance covers 100%.
Difference between billed and paid?
Billed is full charge; paid is what insurance covers
Insurance paid $0—what next?
Check denial reason, correct & resubmit
what report shows unpaid claims?
Aging Reports
What is “coordination of benefits”?
Determining primary and secondary insurance coverage.
When is a claim denied?
When info is missing, not covered, or authorization needed
How do you bill a balance?
Send statement, follow up as needed