The Difference Between an R/a and an Eob

The difference between remittance advice (RA) and EOB is that the RA summarizes the results of the payer’s adjudication process. Whether sent electronically or in a paper format, the basic information in the transaction is the same, although the appearance of the documents is often different. Explanation of benefits is the means by which commercial and government healthcare programs notify their beneficiaries of how an individual healthcare claim was processed for payment. It contains the date of service, the code used to bill a particular service to an insurance company, the fee charged by the healthcare provider, the allowed amount under the third-party payers’s contractual fee schedule, the patient’s responsibility under the terms of their coverage, the payment made by the payer, and the contractual write-off. They inform their patients of expected financial obligations for healthcare received, such as copays, co-insurance, and deductibles. They also inform patients that they may have received services that a payer considers medically unnecessary, experimental, or cosmetic in nature. The only major difference between the two statements is the statement provided to the patient on the explanation of benefits that it is not a bill. (Medical Billing and Coding, 2017) Both types of statements provide an explanation of benefits, but the remittance advice is given directly to the health-care provider or physician, and the explanation of benefits statement is sent to insured patient. (Valerius, Bayes, Newby, & Seggern 2014)

I believe that the RA/EOB is an effective method of communicating claim adjudication information to patients. I think it is a good system. Even though the physician’s copy shows the information for several patients, the patient’s copy shows individual patients their own information for HIPAA compliance. Both statements contain information regarding the patient, the service provider, and all adjustments (if any) made to any claims. Both include the type of procedure performed, when it was performed, and the cost of services rendered. Additional information regarding the patient's benefits is often included as well, including the details of their plan, such as co-payments and deductibles. If payment is denied, an explanation is provided on both statements. The only major difference between the two statements is the statement provided to the patient on the explanation of benefits that it is not a bill. I do not recall ever receiving an RA/EOB, so I am not sure if it is easy or difficult to understand. If I were to make a suggestion, I would say that both statements should be put in laymen’s terms, so that it would clearly explain the EOB, and if the patient has any questions contact information should be included. If I were working directly with patients during appointments, I would attempt to answer any questions they may have, and give them an estimate of what their insurance is paying for, and what they are responsible for.