How to read an EOB | Medical Billers Edition Volume 1

Are you confused about how to read EOBs (explanation of benefits) or just curious about what one looks like? In today's video, we are delivering a request from Keisha in our community, who asked for a quick tutorial summarizing how to read an EOB as a medical biller
❓❓ Do you have a question about the revenue cycle or the business of healthcare? Drop your question below!
#eob #medicalbiller #howtoreadaneob
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Who is Jasmine?
Jasmine Vializ is the Founder of IPS Learning Institute. IPS Learning Institute is an education firm committed to enhancing the delivery of healthcare by providing quality training to the business side of healthcare.
Jasmine Vializ is a healthcare advisor, speaker, and leader. Jasmine uses her passion for people and two decades of healthcare leadership experience to usher in the next generation of medical billers and take organizations to new levels of efficiency and effectiveness. She is highly skilled at developing systems positioning an organization to scale while delivering exceptional services to its clients and patients. As a result, during 16 years of owning her medical billing & credentialing firm, her clients experienced an average of 20% in growth during the first six months of working with her organization. Jasmine operates from her core mission to improve the delivery of patient care by alleviating the stress and confusion from the business side of healthcare.
Who is Rene?
Rene Lumene is an accomplished healthcare operation leader with a diverse professional background. A highly accomplished health care executive with over 16 years experience and has the ability to balance strategic decisions and financial discipline with a hands-on approach to leadership-resulting in strong employee, patient, and physician satisfaction. Engaging communicator and relationship builder with expertise in organizational planning, multimillion-dollar operational budget, contract negotiations, consulting, team development, and increasing visibility for growth.
Rene is a graduate of Webster University and double Masters’ major in Business Administration and Healthcare Administration. He completed his undergraduate study at Bellevue University to earn a Bachelor’s in Healthcare Management. An entrepreneur at heart and an inspiring leader in life and in business. His experience working at major healthcare organizations, military including local healthcare systems, has allowed Rene to experience healthcare from all spectrums.

Пікірлер: 70

  • @sudalairaja1439
    @sudalairaja1439 Жыл бұрын

    Great effort of training Jasmine. I also learnt EOB today.. Thank you🙂🙂☺☺

  • @InleraU

    @InleraU

    Жыл бұрын

    Such kind words. You're welcome! Always happy to help people learn :)

  • @mohdyounus4155
    @mohdyounus415510 ай бұрын

    i love you jasmine❤❤❤❤thanks for the explanation

  • @ruchiraina15
    @ruchiraina15 Жыл бұрын

    Hi! Love your videos for their exceptional clarity! Could you please make one on payment posting? Thanx

  • @InleraU

    @InleraU

    Жыл бұрын

    Hi, thanks so much for the feedback! I will definitely add that to our list of ideas, keep an eye out for it in a future video!

  • @sharmilatapkir4787
    @sharmilatapkir47872 жыл бұрын

    Wow Great Job 👌👏

  • @InleraU

    @InleraU

    2 жыл бұрын

    Thanks a lot 😊

  • @samj5398
    @samj5398 Жыл бұрын

    I absolutely hate that every payor EOB is different 😫 it makes coordination of benefits so difficult!

  • @InleraU

    @InleraU

    Жыл бұрын

    Ugh tell me about it!! & for this reason, I need to do more example videos. Seeing more you will eventually get to know the different variations but, yes, it is a pain!

  • @BMW310R
    @BMW310R Жыл бұрын

    Thanks for the video

  • @InleraU

    @InleraU

    Жыл бұрын

    Thank you for watching!

  • @knightlyrose4719
    @knightlyrose4719 Жыл бұрын

    Thanks for your explanation! CPT 27866 is for Amputation (leg) allowed amount is 76.70 that's very surprising.

  • @InleraU

    @InleraU

    Жыл бұрын

    You're welcome! Yes, it can be surprising to find out the allowed amounts, but that's part of the fun isn't it!

  • @keyshianorman6
    @keyshianorman62 жыл бұрын

    This so helpful thank you

  • @InleraU

    @InleraU

    2 жыл бұрын

    Yay!!! SO Glad to hear it was helpful! I will be releasing more on this topic in the coming days. And the font size will be better :)

  • @SheaButterBallin
    @SheaButterBallin2 жыл бұрын

    Thank you for the video! Could you please make one that has how much co-ins, ded etc instead of zero?

  • @InleraU

    @InleraU

    2 жыл бұрын

    Yes!!! I will have it up in the next couple of week. I appreciate your comments :-)

  • @nataliejones2894
    @nataliejones2894 Жыл бұрын

    When you said over 20 years of experience I was so baffled because you look about 25. I love your channel and will be scouring it for more videos !!! Thank you for sharing your wealth of knowledge in such a concise way!❤

  • @InleraU

    @InleraU

    Жыл бұрын

    Haha, thank you so much for the compliments! Glad to hear you’re appreciating the content :) If you are looking for anything specific or have any questions, let us know!

  • @Vita-a-stelle-e-strisce
    @Vita-a-stelle-e-strisce2 ай бұрын

    If you think about it you need insurance only in countries where costs of providers are sky high. In many countries you don’t need insurance because providers have honest prices. You pay the fair amount and you go home and that’s it, you will not receive anything to pay by mail once you leave the specialist’s office.

  • @giseladaniel7474
    @giseladaniel747411 ай бұрын

    It would have been helpful to have actual copay / co-ins / and reason codes reviewed. Maybe a more detailed EOB for this training?

  • @InleraU

    @InleraU

    7 ай бұрын

    Thank you for your feedback! I will absolutely take this into consideration for the next one!

  • @ianbrie3416
    @ianbrie34162 жыл бұрын

    I worked ER registration for 22 years and decided to work in billing as a insurance follow-up and denials. I understand how to get things answered but when it comes to adjustment I tense up because I don't get it. 😬 I don't understand what order to calculate so I Can make an adjustment. I almost want to quit because it makes me feel so stupid. Managers explain to intensely and I'm an analytical thinker and they think fast. I just don't get if we do an adjustment to the ins company. I need to know the step by step instructions on how I should arrive at my adjustment. Also crowns and puppets help

  • @SheaButterBallin

    @SheaButterBallin

    2 жыл бұрын

    Are you still working there? If so I can give you some tips. If not, I don’t want to type a huge paragraph in detail for no reason lol

  • @InleraU

    @InleraU

    2 жыл бұрын

    Oh no! So sorry, just seeing your comment. How is it going? It sounds to me like you are doing some payment posting? Perhaps a job where you are only doing higher level appeals or disputes would satify the analytical thinker in you. Due to volume, most billers are expected to be quite quick decision makers. Coding research and appeals move a bit more slowly and require more in depth analysis.

  • @InleraU

    @InleraU

    2 жыл бұрын

    See my reply below. Does that help you?

  • @AmbikaBharath

    @AmbikaBharath

    2 жыл бұрын

    @@SheaButterBallin I'm from India working as AR follow-up and find difficult to work on denials could u help me out please., if u dont mind

  • @SheaButterBallin

    @SheaButterBallin

    2 жыл бұрын

    @@AmbikaBharath I’d love to help! What part is difficult? A denial is the payer deciding not to pay the claim. The gist is there are different types of denials. You can find the reason by looking at the EOB(Explanation of Benefits), calling the payer, or logging onto a portal such as Availity to get the reason they denied. Then most times you may be able to send an APPEAL. Which is you telling the payer that you don’t agree with their denial and providing documentation why you are right in saying the claim should be paid. A common denial reason I saw was insufficient medical records. In which case, I would gather up all available records(will vary depending on what the speciality is.) And send it over to the Payer along with a letter…usually a template from my company that’ll say “please reconsider blah blah” and letting them know how much the provider should receive based on the contracted rate of pay. Some payers prefer you mail, fax, or upload appeal to their portal. I hope that helps. Let me know of you have more questions.

  • @ZAMGAMINGZONE512
    @ZAMGAMINGZONE512Ай бұрын

    HI, Jasmine, thanks for making such an informative video, I have a question: You have mentioned the provider's responsibility, how it would happen that a provider will agree to pay his responsibility happily. however, the provider will cure the biller and reject his contract. what do you think?

  • @crystalpayne5152
    @crystalpayne51522 жыл бұрын

    In the video you state you will have more examples, where can I find those videos?

  • @InleraU

    @InleraU

    2 жыл бұрын

    Thanks for your question! We took a little break from creating videos but now we are back and you will see some additional examples in the next couple of weeks.

  • @Tamarkia
    @Tamarkia Жыл бұрын

    I've worked in Healthcare for the past 20yrs in various types of positions and I'm trying to get a job as a Claims Analyst. what type of training do you recommend?

  • @InleraU

    @InleraU

    Жыл бұрын

    Thanks for your question. I think I need to understand more about the "claim analyst" position first. Is this on the insurance side or provider/organization side?

  • @yowter8265
    @yowter82652 жыл бұрын

    Is EOB applicable for homemaker service and home health aide?

  • @InleraU

    @InleraU

    2 жыл бұрын

    If you are billing commercialy or federral insurance carriers then yes it would be applicable.

  • @jaydeepgokani870
    @jaydeepgokani8706 ай бұрын

    Hey. Can you make a videos on FQHC Medical Billing and how does it work. And how different it is from other Billing? Thanks.

  • @InleraU

    @InleraU

    4 ай бұрын

    Thanks so much for your comment! Yes, I am working on FQHC related content now. Let me know what other specific questions you have so I can make sure that we cover them in future videos.

  • @tigergold999
    @tigergold9993 ай бұрын

    My wife always has me look up our medical insurance EOB online to see if it's been updated and see if we owe anything. My question is: our med ins. gives us a discount on the total amount and puts the amount we owe at the far column. Why do some medical facilities still send out a bill for the discount when our EOB says "Patient Responsibility" = $0.00?

  • @yowter8265
    @yowter82652 жыл бұрын

    Where can the provider can get the EOB? I thought that the patient only has the ability to receive or access the EOB?

  • @InleraU

    @InleraU

    2 жыл бұрын

    The provider would need to reach out to the carrier for access to the insurance online web portal. The common term used for payments made to patients is EOB and we use it for the payment to providers too but the proper term is Remittance Advice.

  • @nabilakharal4735
    @nabilakharal4735 Жыл бұрын

    Can you please show tutorial how to read Medicare RA?

  • @InleraU

    @InleraU

    Жыл бұрын

    Thanks so much for the feedback! I will definitely add that to our list of ideas, keep an eye out for it in a future video!

  • @anthonyrios4003
    @anthonyrios4003 Жыл бұрын

    Co pays confused about them. My EOB said 0.00 for co-pays but the allowance is 103. what does this means

  • @sophiegrl5914

    @sophiegrl5914

    Жыл бұрын

    Allowance is what they allow for payment/deductible/copay in the contract. So if there is no co-pay or deductible then the allowance should be the full payment they give you.

  • @InleraU

    @InleraU

    Жыл бұрын

    It means you do not owe for the copay and as long as there is no deductible you do not owe for that visit and if you paid you should reach out to the provider to see if you have a credit and can get a refund.

  • @ArmieleneBernal
    @ArmieleneBernal8 ай бұрын

    So who pays for the difference for the amount of the procedure and the allowable amount?

  • @InleraU

    @InleraU

    7 ай бұрын

    Thank you for your comment! If you are in network, that amount is adjust it off according to your contract. If you are not a network, then you are able to bill the remainder to your patient. However, you’re going to want to have communicated in advance, the fact that you were not in that work to prevent any issues with surprise billing.

  • @poojavyas41
    @poojavyas41 Жыл бұрын

    How to pulled out eob from the insurance company online plz help

  • @InleraU

    @InleraU

    Жыл бұрын

    That can be tricky, it does depend on the program being used, and sometimes the insurance company. Would you be able to provide a little bit more information?

  • @thulirogers4021
    @thulirogers40212 жыл бұрын

    what is the meaning of finalized-the claim/encounter has completed the adjudication cycle no more action will be taken

  • @iamecaidg

    @iamecaidg

    2 жыл бұрын

    The claim has been studied so whatever the decisions of the insurance company on how much they are going to pay the providers then, that's it.

  • @InleraU

    @InleraU

    2 жыл бұрын

    Hmm well it mean they have completed processing of the claim.

  • @InleraU

    @InleraU

    2 жыл бұрын

    Hmm I am not following your comment. Please try to re-explain.

  • @stephendemko3590
    @stephendemko3590 Жыл бұрын

    Is there a REASON CODE TABLE?

  • @samj5398

    @samj5398

    Жыл бұрын

    You can Google it. That's what I do.

  • @InleraU

    @InleraU

    Жыл бұрын

    Yes, if it is electronic & coming in an ANSI standard format they come from a nationally published resource that can be found here: x12.org/codes/claim-adjustment-reason-codes

  • @sarahcastro1977
    @sarahcastro197711 ай бұрын

    What is Garnishment???

  • @InleraU

    @InleraU

    7 ай бұрын

    Garnishment is typically an amount being taken due to a court order.

  • @corrinemcdowell6842
    @corrinemcdowell684211 ай бұрын

    So is this saying that the patient pays the $611.22?

  • @InleraU

    @InleraU

    7 ай бұрын

    Thank you for your comment! No, this is stating that the insurance is reimbursing that amount. In that particular example, there is no patient responsibility.

  • @sarahcastro1977
    @sarahcastro197711 ай бұрын

    Can you provide us the word languages in Our Career?

  • @InleraU

    @InleraU

    11 ай бұрын

    Hi Sarah, can you elaborate on what you mean by that?

  • @vishnupriya8442
    @vishnupriya84422 жыл бұрын

    Can I call you through WhatsApp... Regarding iv

  • @InleraU

    @InleraU

    2 жыл бұрын

    Hello & thank you for your comment. What did you need help with?

  • @waleedbaig2701
    @waleedbaig27014 ай бұрын

    I want to work as a Medical biller can I work for you

  • @InleraU

    @InleraU

    3 ай бұрын

    Unfortunately we don't have any positions open at the moment, but the Medical Billers Network facebook page is a wonderful place to network ❤️ We also have a playlist for advice on getting hired: kzread.info/head/PLgzxQ8JwGid-jYzvpCOVNShKqVSV7aaqT&si=4ickK6ADCDFvErjS Best of luck!

  • @waleedbaig2701

    @waleedbaig2701

    3 ай бұрын

    I want to work and learn even if you give me tasks ill be happy to work on. Its because i want to learn the whole RCM.I can work for free for first 2 Months@@InleraU

  • @Hardlyatwork
    @Hardlyatwork Жыл бұрын

    I hate all these health insurance companies tbh

  • @InleraU

    @InleraU

    Жыл бұрын

    They can be difficult sometimes for sure!