Wednesday, July 7, 2010

How to review EOB - AR specialist

Explanation of Benefit (or Remittance Notice) Analysis

> Determine why the claim was denied by analyzing the denial codes, which are usually on the bottom or back of the EOB

> Cross-reference actual reimbursement from the payer to their allowables to determine if the claim was underpaid, paid correctly, or overpaid. Allowables are often published in provider bulletins or in your contract with the payer

> If the payer has changed any of your codes, you may want to go back and review how you’re using those codes and whether they are being used appropriately

> Take care to file appeals within the time constraints of the payer (for Medicare, the limit for appeals is 120 days from the date of initial denial); keep in mind that a payer may require a specific appeal form to be submitted

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