Thinking it Through ch 8

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Mountain Empire Community College *

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271 A81.

Subject

Chemistry

Date

Feb 20, 2024

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docx

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1

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1. Wayne Elliot asks you why he was charged for two office visits when his daughters, Emily and Rose, were seen at the same time in the same room for the same problem-an earache. Explain the reasoning behind the charges. He would be charged for Emily and Rose separately because they are two different people regardless of using the same room and time. Both were seen so they have to both be charged. 2. You receive an EOB for a patient who is covered by an HMO. The HM0 did not pay for services received on May 5, which is when the patient visited Dr. Larsen for her annual PET scan. You check your records and find that the same insurance carrier paid for previous PET scans for the same patient in past years. What should you do? I would resubmit the claim to see if that fixes the problem. If that did not fix it I would contact the Insurance provider to see what could be done for the patient. 3. You receive an ERA from Blue Cross Blue Shield for a Medicare patient. The amount received for the claim is $60, which is $20 less than the provider's usual fee of $80. Since the doctor you work for accepts assignments for Medicare patients, the medical practice will need to write off this amount. You decide to delete the initial fee of $80 in the computerized patient ledger and key in $60, so that the account balances. Why is this a mistake? This is a mistake because you are supposed to make a correction, change, or write- off with adjustments to the existing transactions. In this case you would be doing a write-off of the amount of $20 to the existing transaction. 4. You notice that an elderly patient is scheduled for a minor surgical procedure that will remove unsightly dark patches of skin, a procedure that is considered cosmetic by most insurance companies. Why is it a good idea to point this out to the patient before the procedure? The procedure is considered cosmetic by most insurance companies so they may not pay for the procedure. The patient may need to discuss the procedure with their insurance company before having the procedure or they may end up having to pay out of pocket for the procedure.
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