Case 8.3 Calculating Insurance Math
A physician’s usual fee for a routine eye examination is $80. Under the discounted fee-for-service arrangement the doctor has with Plan A, the fee is discounted 15 percent for Plan A members. This month, the doctor has seen five Plan A members for routine eye exams.
1. What is the physician’s usual fee for the five patients? $
2. What will the physician be paid for one Plan A member’s exam? $
3. What will the physician be paid for the five Plan A eye exams? $
Homework Answers
Case 8.3 Calculating Insurance Math Part 2
Using this fee schedule for three different payers for orthopedic procedures, complete the questions that follow.1. A patient with BCBS PPO coverage had surgical knee arthroscopy with medial and lateral meniscectomy. The plan has an 80-20 coinsurance, with no copayment for surgical procedures. The annual deductible is met. What will the plan pay, and what amount does the patient owe?2. A United patient has a high-deductible plan with a $1,200 deductible for this year that has not been met and...
25. An insurance plan that pays a bonus based on quality is called a. a DRG...
25. An insurance plan that pays a bonus based on quality is called a. a DRG plan. b. an HMO plan. c. a capitation plan. d. a value-based plan. bovina doo bolovni deos bovlower a m gods to 26. Under a capitation plan, Sound in 193672 a. payments to providers depend on the number of episodes of care. b. patients pay a share of the bill rather than a set fee. Tot Juoda c. patients pay a set fee for...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate the insurance in each of the following situations. Upload your completed worksheet to the 3.4 Case Study dropbox. A. A patient's insurance policy states: Annual deductible: $300.00 Coinsurance: 70-30 This year the patient has made payments totaling $533 to all providers. Today the patient has an office visit (fee: S80). The patient presents a credit card for payment of today's bill What is the...
Outpatient Insurance Coding - Applying Concepts Ch 1
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Ch 16 Case Studies #8
As with a Medicare RA, when a commercial RA is received, before posting payments and preparing secondary claims that may be required you must carefully review it. When analyzing an RA from a commercial carrier, you must be familiar with the guidelines of that carrier’s particular plan. The type of services covered and the percentage of the coverage will vary, depending on whether the plan is a fee-for-service plan, a managed care plan, a consumer-driven health plan, or some other...
Hello there could you please answer to this question. CHAPTER 16 Basics of Health Insurance 315...
Hello there could you please answer to this question.
CHAPTER 16 Basics of Health Insurance 315 of different at a fixed have sepa association thcare pro providers er fee-for- 5. Rather ae HMO nt's PCP with the annually the cost Preferred Provider Organization APPO is a managed care nework that contracts with a group of providers the providers are on a predetermined list of charges for all services, including those for both normal and complex proce- dures. The PPO model...
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1. The patient is insured by a PPO with 100 percent coverage after a copay of $15. The patient was seen in the office for a checkup, and the total charges were $115. What amount must the patient pay? When? What amount must the insurance plan pay? When?2 Afaf Darcy is insured by an HMO with a $10 copay and out-of-network coinsurance on charge balances of 90-10. She needed ysical therapy after her knee replacement. Her HMO pays for eighteen...
Ch 16 Case Studies #3
When a practice receives an RA from a carrier, the payment received for each procedure is posted to each patient’s account. If any patients on the RA have secondary coverage, secondary claims are then prepared unless they have automatically crossed from the primary to the secondary payer. Before doing so, however, the practice analyzes the RA to make sure the payments received are in keeping with what is expected given the office’s fee schedule, the patient’s insurance plan, and any...
Read the case "Last Chance Hospital" and write a case study report, use chapter 17 as...
Read the case "Last Chance Hospital" and write a case study report, use chapter 17 as a guide. Requirements: Write a two (2) to three (3) paragraph essay in APA format. Answer the case study and outcome of your research in detail. Reports will be graded on following chapter 17 guidelines, grammar, sentence construction, spelling, punctuation, quality of analysis, solutions, and recommendation. Last Chance Hospital (LCH) is a 254-bed, community hospital located in a small, affluent suburb just outside of...
4. Aentify tive practices that are beyond the scope of practice of medical assistants. a. c....
4. Aentify tive practices that are beyond the scope of practice of medical assistants. a. c. d. e. Allied Healthcare Occupations and Licensed Medical Professions Match the following descriptions with the appropriate healthcare occupation. a. Audiologist Provides services such as injury prevention, assessment, and rehabilitation 1. b. Diagnostic cardiovascular Is qualified to implement exercise programs designed to reverse or minimize debilitation and enhance the functional capacity of medically stable patients 2. c. Therapeutic recreation spec d. Physical therapist e. Pharmacy...
25. An insurance plan that pays a bonus based on quality is called a. a DRG plan. b. an HMO plan. c. a capitation plan. d. a value-based plan. bovina doo bolovni deos bovlower a m gods to 26. Under a capitation plan, Sound in 193672 a. payments to providers depend on the number of episodes of care. b. patients pay a share of the bill rather than a set fee. Tot Juoda c. patients pay a set fee for...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate the insurance in each of the following situations. Upload your completed worksheet to the 3.4 Case Study dropbox. A. A patient's insurance policy states: Annual deductible: $300.00 Coinsurance: 70-30 This year the patient has made payments totaling $533 to all providers. Today the patient has an office visit (fee: S80). The patient presents a credit card for payment of today's bill What is the...
Hello there could you please answer to this question.
CHAPTER 16 Basics of Health Insurance 315 of different at a fixed have sepa association thcare pro providers er fee-for- 5. Rather ae HMO nt's PCP with the annually the cost Preferred Provider Organization APPO is a managed care nework that contracts with a group of providers the providers are on a predetermined list of charges for all services, including those for both normal and complex proce- dures. The PPO model...
4. Aentify tive practices that are beyond the scope of practice of medical assistants. a. c. d. e. Allied Healthcare Occupations and Licensed Medical Professions Match the following descriptions with the appropriate healthcare occupation. a. Audiologist Provides services such as injury prevention, assessment, and rehabilitation 1. b. Diagnostic cardiovascular Is qualified to implement exercise programs designed to reverse or minimize debilitation and enhance the functional capacity of medically stable patients 2. c. Therapeutic recreation spec d. Physical therapist e. Pharmacy...
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