Physicians always wish to get reimbursement in the first attempt. To get the reimbursement in the first attempt providers need to eliminate some repetitive errors. This can happen if the provider or their hired staff for billing can read EOB or ERA interpret correctly and understand. There is always some percentage of getting claims denied. Read further how to read EOB and you can boost your collection.
Two to three weeks after claims submission the medical practitioner will receive a reply from the payor in the form of EOB/ERA to inform them about their decision as to whether the claim will be paid or denied.
Difference between EOB and ERA:
The difference between these two is the delivery method.
EOB: Explanation of Benefits
The EOB is generated when the provider submits a claim for the services provided by him to patients. An EOB receives a provider via traditional mail. Payment will be sent as a check via traditional mail.
The insurance company sends you EOBs to help make clear:
- The cost of the care provided by the physician
- Any money you saved by a patient visiting in-network providers
- Any out-of-pocket medical expenses patient will be responsible for
ERA: Electronic Remittance Advice
An ERA, name itself suggests that it will be sent electronically. If there is a payment associated with the ERA, it will either be sent as a check via traditional mail or delivered by EFT (electronic funds transfer often known as direct deposit). Though you are enrolled for ERA you need to associate your bank details so that they can initiate a direct deposit.
ERA is faster than EOB as it will be received to you the day when they release it.
Why EOB or ERA?
The purpose of an EOB or ERA is to provide payment and denials details to the provider for the claims they submitted. It will explain the amounts, such as deductibles, co-insurance, and co-payments, that the patient is responsible for paying out of pocket. Finally, the EOB or ERA will show you how to properly apply the payments to patient’s accounts so you can keep track of what is paid and what is outstanding.
To keep a track of payments and patient responsibility amount details the biller must enter all information from the EOB into the practice’s practice management software e.g. Brightree, AdvancedMD, etc.
Benefits of entering information into Billing software:
- It helps to understand overall reimbursed amount and taxes
- Patient responsibility amount to be collected
- Unpaid or incorrectly paid claims need follow up
Inside of EOB/ERA:
- Your name, or the name of your dependent (whoever received the service)
- The name of the health care provider who administered care – doctor, dentist, specialist, laboratory, hospital, or clinic
- Your (or your dependent’s) health insurance ID or policy number, and the claim number
- The type of service or equipment you received and the date on which you received it; for service that lasted more than one day, the date range will be given
- The cost of the service (what your provider billed the insurance company)
- How much of the billed amount your insurance company paid?
- The remaining amount to be paid, which is usually your responsibility
The allowed amount is the maximum payment that you can receive on each line item. The difference between the insurance’s allowed amount and your charge amount is called the contract adjustment. The contract adjustment is a write-off.
The difference between the allowed amount and the payment amount, that balance is the patient’s responsibility (out of pocket). A deductible is a patient’s annual out-of-pocket payment before insurance will begin paying.
A co-pay is a small out of pocket amount due for each visit. It is usually paid prior to seeing the doctor. The patient’s co-insurance is a share of the bill. It is usually a percentage of the allowed amount.