An Explanation of Benefits (EOB) is a statement that a health plan sends to the
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Medical Office Assistant · Medical Economics, Billing, and Coding
Explanation of Benefits and Remittance Advice
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A patient calls and asks to pay the amount printed on their Explanation of Benefits. The most accurate guidance is that the EOB
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A remittance advice (RA) is primarily sent by a payer to the
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The standard electronic format for a remittance advice under HIPAA is the
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A patient is confused because they received an EOB showing $0 patient responsibility. The best explanation is that
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Study tools & related lessonsYou’ll learn to · Related
You’ll learn to
- Distinguish an Explanation of Benefits from a remittance advice, including who receives each and how each is used.
- Interpret payment, adjustment, and patient responsibility amounts on an EOB and a remittance advice, including group and reason codes.
- Post payments and adjustments accurately to the correct patient account and claim line, and reconcile posted totals to funds received.
- Recognize when to escalate discrepancies, overpayments, credit balances, refunds, and cost-sharing questions to billing or authorized staff per office policy.
Sources & references
- Centers for Medicare & Medicaid Services — CMS.gov
- American Health Information Management Association — AHIMA - Health Information and Coding
- AAPC — Medical Coding and Billing
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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