Healthcare Compliance Tips
Accounts Receivable [Healthcare Compliance Tips]
Healthcare Compliance Tips
Non-Covered Services [Healthcare Compliance Tips]

Insurance Companies & EOBs [Healthcare Compliance Tips]

Study and increase your knowledge of insurance company’s processes.

The previous tip kicked off our series called “Dear Provider: Don’t Give Up,” highlighting the lack of peace physicians have due to changing regulations and the pandemic.

And, it’s no secret the battle physicians have with:

Insurance Companies and Explanation of Benefits (EOBs)

You face choosing the best treatment plans or medications based on the patient’s coverage, which puts you further into the healthcare conundrum.  Even patients are confused by insurance companies!

In a previous Becker’s CFO Report:

77 percent of consumers reported they were confused by an explanation of benefits they received from their health plan and 76 percent were confused by bills from their providers.

So, how do we increase your understanding of insurance companies to reduce patient frustration and compliance risk?

Here are a few suggested tips, such as:

  • Don’t just sign the insurance contract, negotiate! Know your numbers, data, and practice goals before reaching the insurance negotiation table.  Even after the negotiation, keep a close eye on the contract and note areas of concern for upcoming reviews.
  • Talk to your insurance provider relations representative regularly, since they provide more information than customer service representatives. They help you understand your contract and provide tips or trends regarding the insurance company.  Schedule monthly or quarterly meetings to identify and remediate claims.
  • At check-out and over the phone, explain EOBs and practice billing statements to patients thoroughly. Provide contact information for the accounts receivables department regarding future questions.  Patients want to pay their bills.  But cloudy reports or explanations will cause them to toss it aside and pay for the latest gadget on the market instead.  Stay in contact!

Remember, this will take time and a little studying on your part to enact within your practice.  Review compliance risks surrounding each decision, especially when patients are involved (we don’t want them to complain to the insurance company or government).  Once you nail down this area, your practice will run more efficiently.


**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify and tailor the advice to fit your specialty.

Click here for the next tip in the series.

Joi Sherrod, MPH, CPC, CPCO
Joi Sherrod, MPH, CPC, CPCO
Joi is an educator and owner of JNC Healthcare Compliance Group. After working for distinguished academic teaching hospitals and clinics, she is passionate about helping medical, dental, and behavioral health practices rethink healthcare compliance one trend at a time. Contact Joi at