CPB Certified Professional Biller Certification Practice Exam

Which document is mailed by the payer to the patient detailing the reimbursement amount of a covered benefit?

1. Claim Summary

2. Explanation of Benefits

3. Patient Invoice

4. Benefit Statement

The correct answer is: Explanation of Benefits

The correct answer is the Explanation of Benefits, often abbreviated as EOB. This document serves a critical function in the healthcare billing process by providing patients with vital information regarding the reimbursement amount for a covered benefit. It breaks down the services received, identifies the billed amount, details what the insurance company will cover, specifies any adjustments made, and outlines the patient’s financial responsibility, including deductibles, copayments, and any coinsurance that may apply. The EOB not only aids patients in understanding their insurance coverage but also promotes transparency in healthcare costs, as it informs them about what has been approved, what was denied, and the reasons for those decisions, thus facilitating better engagement with their healthcare expenses. Other options present different contexts: a Claim Summary typically summarizes the details of claims submitted but is not specifically tailored for patient communication regarding reimbursements. A Patient Invoice usually reflects the total amount due from the patient for services rendered, while a Benefit Statement may outline eligibility and coverage for services but lacks the detailed reimbursement breakdown provided in an EOB. Therefore, an EOB is specifically designed to communicate reimbursement details to patients in a clear and understandable manner.