Dedication
is text is dedicated to all of you who have struggled with understanding the explanation of
b enets (EOBs) from your insurance company that was sent to you after receiving healthcare
services. In some cases, you may be reviewing EOBs for family members and loved ones. ese
EOBs seem almost unfathomable relative to the way in which claims are paid, or not, for health-
care services.
While this is the fourth text in a series of books devoted to healthcare payment systems, we
have really just scratched the surface of a complex and continuously evolving area. Most of the
concepts discussed can be grasped by interested laypersons as well as those professionals involved
in the healthcare services industry. I invite interested readers to be patient with themselves. You
may have to read and then reread certain sections to grasp the concepts presented. Small case
studies are used in this text as they were in the preceding three texts. ese are used to assist in
explaining and illustrating certain issues. My objective is not only to explain; it is to explicate.
I wish to acknowledge the many students who have attended my workshops over the years. We
have discussed numerous, intricate topics and attempted to develop policies and operating pro-
cedures when guidance from Medicare and other private payers is less than precise. Compliance
issues have always loomed large in our discussions, particularly the possibility of inadvertently
receiving overpayments for services.
For all our readers, enjoy the technicalities. For healthcare payment, everything seems to be
in the ne print.
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