MOA115_WK5_Online Lab_CSanson
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Fortis Institute, Port Saint Lucie *
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Course
MAS115
Subject
History
Date
Feb 20, 2024
Type
Pages
5
Uploaded by BarristerFreedomRaven30
MOA115 Medical Records and Insurance Week 5 Lab –
Claims Simulation Chapter 15 Medical Billing and Reimbursement Essentials - Part 2
A. Medical Billing Process 1.
List four types of information collected when a patient calls to schedule an appointment. a.
__________________________________________________________________ b.
__________________________________________________________________ c.
__________________________________________________________________ d.
__________________________________________________________________ 2.
At the time of the appointment, what two things are copied or scanned into the computer? a.
__________________________________________________________________ b.
__________________________________________________________________ 3.
Describe how the patient’s insurance eligibility is confirmed. ________________________________________________________________________
________________________________________________________________________ 4.
Referring to the information on the ID card, answer the following questions.
MOA115 Medical Records and Insurance Week 5 Lab –
Claims Simulation a.
What is the member’s name? __________________________________________________________________ b.
What is the member’s ID number? __________________________________________________________________ c.
What is the group number? __________________________________________________________________ d.
Who is the member’s primary care provider (PCP)? __________________________________________________________________ e.
What is the effective date of the plan? __________________________________________________________________ f.
What is the deductible for prescriptions (Rx)? __________________________________________________________________ g.
What is the copay for primary care (PC)? __________________________________________________________________ h.
What number should the patient call if he has a concern? __________________________________________________________________ i.
What number should you call if you need to get a preauthorization? __________________________________________________________________ j.
What number should a healthcare professional working with Dr. Smith call if there is a question about the coverage? __________________________________________________________________ B. Explanation of Benefits Using the explanation to answer the following questions:
MOA115 Medical Records and Insurance Week 5 Lab –
Claims Simulation 1.
For Tai Yan’s office visit, 99205, there is a difference between the Charge Amount and Covered Amount. Based on the reason code supplied what will be done with the difference? ________________________________________________________________________
________________________________________________________________________ 2.
How much is Tai Yan responsible for? ________________________________________________________________________
________________________________________________________________________ 3.
How much will be written off for Jana Green? ________________________________________________________________________
________________________________________________________________________ 4.
How much is Jana Green responsible for? ________________________________________________________________________
________________________________________________________________________ 5.
What is the covered amount services provided to Pedro Gomez? ________________________________________________________________________
________________________________________________________________________ C
. The Patient’s Financial Responsibility Use the following information as you answer the following questions. 1.
During Zach’s first visit of the year, he incurred a $500 bill. Who pays this bill?
________________________________________________________________________
________________________________________________________________________ 2.
During Zach’s second visit of the year, he incurred a $450 bill. Describe how much is paid by Zach and the insurance carrier. ________________________________________________________________________
________________________________________________________________________ Patient: Zach Green Deductible: $750 Coinsurance: 80/20 Patient out-of-pocket expense maximum: $2000
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MOA115 Medical Records and Insurance Week 5 Lab –
Claims Simulation 3.
Zach had surgery, which was his third claim of the year. He had a bill of $5000. Considering the prior visits, what is Zach’s portion of this bill and what is the responsibility of the insurance carrier? ________________________________________________________________________
________________________________________________________________________ 4.
How much is Zach responsible for so far this year considering his first three visits? ________________________________________________________________________
________________________________________________________________________ Part 3 –
Submission Errors and Appeals Directions
:
•
Using online resources research the common errors with claim submission and the appeal process. •
Research the appeal process for either your insurance carrier or an insurance carrier popular in your area. 1.
What are the most common errors when submitting claims? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 2.
How can these errors be prevented? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 3.
What can a medical assistant do to prevent those errors? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
MOA115 Medical Records and Insurance Week 5 Lab –
Claims Simulation 4.
Who can start the appeal process? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 5.
What steps are involved in the appeal process? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________