Remittance Advice and Explanation of Benefits Statements

Difference Between RA and EOB

Remittance advice (RA) and Explanation of Benefits (EOB) are statements that are
used for communicating claim adjudication information to both healthcare providers and
patients. They are largely similar with a few exceptions. The main difference between the two
statements is that while RA is provided to the healthcare provider, EOB is usually sent to the
insured patient (Dunn et al., 2020).

Effectiveness of EOBs and RAs

The two statements are effective in communicating claim adjudication information to
patients because they contain all the relevant information that a patient would need. The
information includes the type of services they received, when the services were performed on
them, and the cost of the services (Dunn et al., 2020). If the services were paid for, the
statements contain details about the payer and other additional information, such as co-
payments and deductibles (Dunn et al., 2020). If the services were not paid, the statements
provide reasons why the payments were denied.

Ease of Understanding EOBs

EOBs are generally easy to read and understand as they contain basic information that
any patient can understand. The statement contains patient identification information, such as
their name and contacts. It then provides details about the healthcare services that were
provided to the patient and the payer of the services (Dunn et al., 2020). Granted, they use
codes when describing the healthcare services that a patient received. However, the codes can
easily be understood with the help of a physician.

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Suggestions for Improvements

I do not think that there is any improvement that needs to be made to RA statements.
However, I believe that a lot can be made to make EOBs more effective. In particular, since
the statement is usually meant for patients, I believe that the use of codes to communicate the
services that they received is problematic. Physicians and other healthcare providers have no
problem understanding information presented in codes. However, patients lack the training to
understand coded information. Thus, I would suggest that all the information presented by
EOB should be in a language that can easily be understood by the patients.

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References

Dunn, A. Gottlied, J., Shapiro, A. & Tebaldi, P. (2020). The Costs of Payment Uncertainty in
Healthcare Markets. Federal Reserve Bank of San Francisco.