星空入口

Think You Don't Need to Know About EOBs? Think Again

Answers to Frequently Asked Questions Shed Light on Your Responsibilities

The devil's in the details when you're handing patients explanation of benefits (EOB) forms - but these quick answers will keep your records ironed out.

Q: Why is it up to the hospital to provide EOBs to a payer when following up on claims?

A: There are two reasons for this requirement, says Sarah Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C. First, the hospital is always responsible for submitting information to Medicare on the beneficiary's behalf, so it is also responsible for distributing that information to the patient. Second, Medicare payment is made directly to the facility, Goodman says. Because the hospital receives benefits due to the patient's care, the patient has a right to know exactly what those benefits entail.

Q: Do payers always require the original EOB? If not, what is an acceptable alternative? Can I just use a printout of the detailed transactions?

A: Not all payers will insist on an original; a copy will usually suffice. In addition, you'll usually need to create a printout with the details of the transactions to accompany the EOB, Goodman says.

Q: Do most intermediaries have one P.O. Box for original claims and one for resubmissions and corrected claims?

A: The answer to this question can vary by payer, but most fiscal intermediaries generally have a different address or mechanism for routing resubmissions and adjusted claims, Goodman says. You should check with your payer to make sure.

- Published on 2003-08-13