Case Study 3- Explanation of Benefits and Payment
Adjudication
Henry, the billing supervisor that Gloria, the biller
responsible for sending out patient statements, had charged several
patients for the balance that insurance had not paid. In discussing
with Gloria, Henry realized that she hadn’t been properly trained
regarding balance billing. He explained that in most managed care
plans, the difference between the amount billed and the amount
allowed by insurance was to be entered as an adjustment and not
billed...