Homework Answers
a, copayment
a copayment is a fixed amount for covered service that patients
should pay to the providers before receiving service, this is for
standard doctor visits.
a deductible is a set dollar amount that a patient has to pay for
medical service before your health insurance plan begins to
pay.
Coinsurance is a percentage of medical charges paid by patients and
rest by health insurance.
Adjudication is a determination of insurance payment after patient
insurance benefits applied for medical claims.
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A set dollar amount that the patient must pay for each office visit is the definition...
Case 7.2 From the Patient Information Form
In the cases that follow, you play the role of a medical insurance specialist who is preparing HIPAA claims for transmission. Assume that you are working with the practice’s PMP to enter the transactions. The information you enter is based on the patient information form and the encounter form. • Claim control numbers are created by adding the eight-digit date to the patient account number, as in AA026-10042029. • A copayment of $15 is collected from...
CALCULATING COINSURANCE AND DEDUCTIBLE Use this information as you answer the follovwing questions Patient: Zach Green...
CALCULATING COINSURANCE AND DEDUCTIBLE Use this information as you answer the follovwing questions Patient: Zach Green Deductible: $750 Coinsurance: 80/20 Patient out-of-pocket expense maximum $2,000 During Zach's first visit of the year, he incurred a $500 bill. Who pays this bill?, During Zach's second visit of the year, he incurred a S450 bill. Describe how the insurance carrier. 1. much is paid by Zach and s Zach had surgery, which was his third claim of the year. He had a...
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition...
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition or answers the question 1. A list of the medical services covered by an insurance policy C. Noncovered services D. Fee-for-service A. Health care claim B. Schedule of benefits 2. Health plans are often referred to as: C. Providers D. Payers A. Policyholders B. Subscribers managed care network of providers under contract to provide services at discounted fees. A. Health Maintenance Organization (HMO) B....
The duties for a medical assistant in different medical facilities are always the same. 1. True...
The duties for a medical assistant in different medical facilities are always the same. 1. True or False 2. Indicate which of the following medical assistant duties are clinical and which are administrative. Indicate clinical with a C and administrative with an A. Scheduling patients Recording test results Preparing patients for examinations Collecting payments at the front desk Changing dressings Taking patient's vital signs Drawing blood Answering the telephone Recording the patient's insurance information Removing sutures The job prospects for...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's principal diagnosis), and it is the condition chiefly responsible for the outpatient services provided during the encounter visit. It is determined in accordance with ICD-10-CM coding conventions (or rules) as well as general and disease specific coding guidelines. Because diagnoses are often not established at the time of the patient's initial encounter or visit, two or more visits may be required before the diagnosis...
The ss Healthcare s. is the maximsm that third-party payers will pay for a procedure or...
The ss Healthcare s. is the maximsm that third-party payers will pay for a procedure or service through a process called credentialing providers need to apply to become a The nesource based relative value scale includes the following three parts aof healthcare organization that constracts with various healthcare usually takes 3 to 10 working days for review and approval. This type of 40 providers and medical facilities at a reduced payment schedule for their insurance memhers 41. Ain) aelerral is...
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure...
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure you sequence them property according to coding conventions and guidelines, including the definition of first-listed diagnosis. Refer to the diagnostic coding and reporting guidelines for outpatient services in your textbook when assigning codes. Fever, difficulty swallowing, acute tonsilitis Chest pain, rule out arteriosclerotic heart disease 2 3 Hypertension, acute bronchitis, family history of lung cancer Lipoma, subcutaneous tissue of left thigh 4. Audible wheezing,...
Case 7.3 From the Patient Information Form
Provider Information Billing Provider Valley Associates, PC NPI 1476543215Address 1400 West Center Street, Toledo, OH 43601-0213Telephone 555-967-0303Employer ID Number 16-1234567Rendering Provider Christopher M. Connolly, MDNPI 8877365552Oxford PPO Provider Number 1011Oxford HMO Provider Number 2567Assignment AcceptsInformation About the Patient:Name Kalpesh ShahSex MBirth Date 01/21/2016Marital Status SingleAddress 1433 Third Avenue, Cleveland, OH 44101-1234Telephone 555-608-9772Employer Not EmployedRace WhiteEthnicity Not Hispanic or LatinoPreferred Language English Information About Insured:Name Raj ShahPatient Relationship to Insured ChildSex MBirthdate 02/16/1987Marital Status MarriedAddress 1433 Third Avenue, Cleveland, OH 44101-1234Telephone 555-608-9772Employer Cleveland...
Evaluate the following case study utilizing the AHIMA Code of Ethics, the AHA Patient Care Partnership...
Evaluate the following case study utilizing the AHIMA Code of Ethics, the AHA Patient Care Partnership and HIPPA guidelines (sample HIPAA Privacy Notice is in Appendix C of textbook). What issues exist in this case study? What are the consequences of the situation? What resolutions are necessary? Jenna Peterson, a 20 year old college student, made an appointment to be seen by Susan Grant, M.D., one of the partners at Mountainside Family Medicine Associates. Jenna had been seeing Dr. Grant...
Evaluate the following case study utilizing the AHIMA Code of Ethics, the AHA Patient Care Partnership...
Evaluate the following case study utilizing the AHIMA Code of Ethics, the AHA Patient Care Partnership and HIPPA guidelines (sample HIPAA Privacy Notice is in Appendix C of textbook). What issues exist in this case study? What are the consequences of the situation? What resolutions are necessary? Jenna Peterson, a 20 year old college student, made an appointment to be seen by Susan Grant, M.D., one of the partners at Mountainside Family Medicine Associates. Jenna had been seeing Dr. Grant...
CALCULATING COINSURANCE AND DEDUCTIBLE Use this information as you answer the follovwing questions Patient: Zach Green Deductible: $750 Coinsurance: 80/20 Patient out-of-pocket expense maximum $2,000 During Zach's first visit of the year, he incurred a $500 bill. Who pays this bill?, During Zach's second visit of the year, he incurred a S450 bill. Describe how the insurance carrier. 1. much is paid by Zach and s Zach had surgery, which was his third claim of the year. He had a...
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition or answers the question 1. A list of the medical services covered by an insurance policy C. Noncovered services D. Fee-for-service A. Health care claim B. Schedule of benefits 2. Health plans are often referred to as: C. Providers D. Payers A. Policyholders B. Subscribers managed care network of providers under contract to provide services at discounted fees. A. Health Maintenance Organization (HMO) B....
The duties for a medical assistant in different medical facilities are always the same. 1. True or False 2. Indicate which of the following medical assistant duties are clinical and which are administrative. Indicate clinical with a C and administrative with an A. Scheduling patients Recording test results Preparing patients for examinations Collecting payments at the front desk Changing dressings Taking patient's vital signs Drawing blood Answering the telephone Recording the patient's insurance information Removing sutures The job prospects for...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's principal diagnosis), and it is the condition chiefly responsible for the outpatient services provided during the encounter visit. It is determined in accordance with ICD-10-CM coding conventions (or rules) as well as general and disease specific coding guidelines. Because diagnoses are often not established at the time of the patient's initial encounter or visit, two or more visits may be required before the diagnosis...
The ss Healthcare s. is the maximsm that third-party payers will pay for a procedure or service through a process called credentialing providers need to apply to become a The nesource based relative value scale includes the following three parts aof healthcare organization that constracts with various healthcare usually takes 3 to 10 working days for review and approval. This type of 40 providers and medical facilities at a reduced payment schedule for their insurance memhers 41. Ain) aelerral is...
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure you sequence them property according to coding conventions and guidelines, including the definition of first-listed diagnosis. Refer to the diagnostic coding and reporting guidelines for outpatient services in your textbook when assigning codes. Fever, difficulty swallowing, acute tonsilitis Chest pain, rule out arteriosclerotic heart disease 2 3 Hypertension, acute bronchitis, family history of lung cancer Lipoma, subcutaneous tissue of left thigh 4. Audible wheezing,...
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