Which document explains payer payment decisions and the patient's remaining financial responsibility after processing a claim?

• A. Explanation of Benefits
• B. Medical history
• C. Encounter note
• D. Appointment reminder

Answer: (A)

After a claim is processed, the document that explains how the payer handled the payment and what the patient still owes is the payer’s remittance advice, commonly called an EOB. This document shows the billed charges, the allowed amount, what the insurer paid, any adjustments, and the patient’s remaining responsibility (such as deductible, coinsurance, and copays). It may also include codes explaining why a charge was denied or reduced. This is the only document that communicates payment decisions and the patient’s final financial responsibility after processing.

A medical history describes past illnesses and treatments, an encounter note documents what happened during the visit, and an appointment reminder is for scheduling purposes.