American Health Information Management Association (AHIMA) Certification Practice Exam

What is the purpose of the Explanation of Benefits (EOB)?

1. To provide a summary of all medical services in a year.

2. To explain services provided and payments made by the health plan.

3. To list upcoming medical appointments for patients.

4. To give details of the insurance policy coverage.

The correct answer is: To explain services provided and payments made by the health plan.

The purpose of the Explanation of Benefits (EOB) is to clarify the services that have been provided to a patient, along with the corresponding payments made by the health plan. An EOB serves as a statement sent by the insurance company to the policyholder after a medical claim has been processed. It includes information such as the type of services rendered, the total amount billed, the amount covered by the insurance, and any patient responsibilities, such as copayments or deductibles. This is crucial for patients to understand how their insurance benefits work and what expenses they may need to pay out of pocket. In contrast, summarizing all medical services provided in a year would involve more comprehensive records than what an EOB offers and would typically be handled through annual statements or other forms of medical records. The listing of upcoming medical appointments pertains more to patient scheduling and usually falls under practice management rather than insurance processing. Finally, while the EOB may touch briefly on coverage aspects relevant to the services billed, its primary function does not extend to detailing the entire insurance policy coverage, which is generally outlined in separate policy documents. Thus, the primary aim of the EOB is to provide clarity regarding the services covered and the financial transactions that occurred as a result.