Certified Medical Assistant (CMA AAMA)Administrative: Billing, Coding and SchedulingEasy
A patient receives a document from her insurance company after a claim is processed, detailing the billed amount, the allowed amount, what the insurer paid, and the patient's remaining financial responsibility. What is this document called?
- ASuperbill
- BExplanation of Benefits
- CAdvance Beneficiary Notice
- DRemittance advice
Show answer & explanationAnswer & explanation
Correct answer: B. Explanation of Benefits
An Explanation of Benefits (EOB) is sent by the insurance company to the patient (policyholder) after a claim is processed, summarizing the charges, allowed amount, insurance payment, and patient responsibility. A remittance advice is the equivalent document sent to the provider, not the patient.
Why the other options are wrong
- A. A superbill is an itemized encounter form used by the provider's office to generate claims.
- C. An ABN is a notice given to Medicare patients before a service that may not be covered.
- D. A remittance advice (RA) is sent to the provider, not the patient, summarizing claims payment.
Explanation of Benefits (EOB)
A statement sent by a health insurance company to the insured explaining what medical services were billed, what was paid, and what the patient owes.
- Sent to the patient/policyholder, not the provider
- Shows billed charge, allowed amount, insurance payment, patient balance
- Not a bill itself — it's a summary of claim processing
Memory trick: EOB explains, RA remits to the office