Reference no: EM133394589

You are a newly hired health insurance specialist at a small medical practice, and you are responsible for completing and submitting CMS-1500 claims. Toward the end of your second day on the job, you're asked to take a phone call from a patient who has questions about his submitted claim. The patient tells you that he just received an explanation of benefits (EOB) from his third-party payer, and it makes no sense because the bottom part of the form that is supposed to include a tear-off check is blank. He tells you that the EOB says he agreed to the assignment of benefits. The patient is upset because he needs that money to buy groceries.

You use the medical practice's electronic health record system to quickly access the patient's record, submitted CMS-1500 claim, and remittance advice the practice received from the payer. You explain to the patient that the physician accepts assignment from this payer. You further explain that according to your file, the account is considered paid in full because the patient paid the $20 copayment at the time of the encounter.

The patient argues that the medical practice owes him money because he was supposed to receive a check from the payer.

1. What is meant by the phrase "assignment of benefits"?

2. What is meant by the phrase accept assignment?

3. What is causing confusion for the patient? How should this be resolved for the patient?