Revenue Cycle Management (RCM) Practice Exam

The purpose of an Explanation of Benefits (EOB) is to detail what services were covered by the insurance policy and the amounts paid by insurers. It serves as an important communication tool between the insurance company and the policyholder. The EOB breaks down the specific medical services received, indicating which ones were approved for coverage, the payment made by the insurance, any adjustments that were applied, and what portion of the charges remains the responsibility of the patient.

This information is crucial for patients to understand their financial obligations concerning healthcare services. It also aids them in navigating their insurance benefits, ensuring transparency in the claims process, and facilitating the resolution of any discrepancies in billing.

Other options do not fully encompass the primary function of an EOB. For instance, while informing patients about the amount due for services is part of the process, it does not capture the overall purpose of EOBs, which is focused on coverage details. A breakdown of service charges is typically found in billing statements rather than an EOB. Summarizing patient histories falls outside the scope of an EOB, which concentrates on specific treatment and payment information.