I have consulted in hospital billing offices for over 10 years and have my first physician office. The questions I have are basic that I know pertain to hospital billing, but I am not sure they pertain to physician billing.
The problem I have having is that copays were collected from the pt at time of service per the eligibility system . When we received payment the eob showed zero responsibility. According to the office staff this is a known problem at the insurance company and the pt was responsible at the time of service although it is not reflected on the eob.
I have always assumed the EOB is the information that the office was suppose to go by. If the EOB is not correct the insurance company must send you a corrected eob. I have also assumed if we do not get a new copy of the the correct eob we should either refund the pt or note who we spoke with and a reference #. Also does anyone know if a penalty is associated with the EOB not matching what the pt was bill and if so how much and do you know where I can find this in writing? I need this information fast and if anyone has any information please email me at janiesanderson@aol.com