CPB Certified Professional Biller Certification Practice Exam

What purpose does the Explanation of Benefits document serve in the billing process?

1. It details costs incurred and payments made by patients

2. It outlines coverage benefits and limitations for policyholders

3. It informs patients about their claims and reimbursement amounts

4. It provides a breakdown of medical services rendered

The correct answer is: It informs patients about their claims and reimbursement amounts

The Explanation of Benefits (EOB) document plays a crucial role in the billing process by informing patients about their claims and reimbursement amounts. It serves as a detailed statement that explains how a particular claim was processed by the insurance company. This includes information such as which services were covered, the amount billed by the healthcare provider, the amount paid by the insurance company, and what the patient is responsible for, including deductibles, copayments, and any remaining balances. This transparency helps patients understand their financial responsibility regarding medical services they received, enabling them to better manage their healthcare expenses. By providing this comprehensive overview of the claims process, the EOB also acts as a communication tool between the patient and the insurance provider, ensuring that patients are fully informed about the status of their claims.