After a patient encounter, the services are coded and a claim is submitted to the third-party provider. The claim will either be rejected or paid. Rejected claims must be corrected and resubmitted. We have discussed some of the reasons for errors in coding in a previous lesson. Once the claim is approved and paid an explanation of benefits (EOB) report is sent to the patient by the insurance carrier to inform them that a claim has been filed. The EOB shows the amounts that were billed, what will be paid by the insurance, and what may be owed by the patient.
Here is a link to an infographic explanation of an EOB from the CMS Links to an external site. that shows the final reimbursement determination, explaining any decision, and reimbursement that may be due to the provider. Claims may be by paper or electronic means. The following list contains terms related to billing and reimbursement.
Review these short videos on Billing Terms Links to an external site. and the basic billing process Links to an external site.. Explain two of the following terms related to billing and reimbursement and provide an example for each. Remember to include it the term relates to paper or electronic billing or both. You may need to research some of the topics on the internet.
Include at least one reference for your information source using APA formatting for the citation. Clearinghouses Claim scrubbers (claim scrubbing) Electronic Data Interchange (EDI) CMS-1500 Advance beneficiary notice Coordination of benefits (COB)
Electronic Data Interchange and Coordination of Benefits to be explained. An article along with two video links to refer to. https://www.medicalbillingandcoding.org/billing-vocabulary-key-terms/ https://www.medicalbillingandcoding.org/billing-process/