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Healthcare Information Technology Exam Guide for CompTIA Healthcare IT Technician and HIT Pro Certifications by Brian Gugerty, Kathleen McCormick

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Payments and Denial Management

Physician practices contract with health plans to receive payment for providing patient services. The process of receiving and processing that payment is complex even in the best-run practices, and successful management of this area of the claims revenue cycle is vital to the financial viability of the organization.

Explanation of Benefits/Remittance Advice

If the practice does not have the capability of accepting an explanation of benefits (EOB) or remittance advice (RA) from health plans in an electronic format, typically then the EOB/RA is mailed to the practice along with the check. Staff must then manually record the payment.

Although the practice may “charge” the health plan a certain amount for a patient ...

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