Payments > Patient Billing

basic physician billing questions.

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janiesanderson:
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 

PMRNC:
No the EOB is not the be all and end all. The document that matters is the actual contract between the provider/facility and the insurance company. Pull the contract and that will tell you everything you need to know. 

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