Read the scenario and then answer the questions.
Lisa Warren is a newly hired health insurance specialist at a small medical practice, and she is
responsible for completing and submitting CMS-1500 claims. Toward the end of her second day on the
job, she is asked to take a phone call from a patient who has questions about his submitted claim.
The patient tells Lisa 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 Lisa that EOB says that he agreed to the assignment of benefits. The patient is upset
because he needs that money to buy groceries.
Lisa uses 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. Lisa explains to
the patient that the physician accepts assignment from this payer. She further explains that according to
her file, the account is considered paid in full because the patient paid her $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 area of confusion is occurring between Lisa and the patient? How should this be resolved
for the patient?