J. Explanation of Benefits Patient Name XYZ Insurance Company Explanation of Benefits Walden-Martin Family Medical Clinic 1234 Anystreet Anytown, AK 12345-1234 Treatment CPT Dates Yan, Tai 01/06/20XX (99205 01/06/20XX 82947 01/06/20XX 86580 Totals Charge Reason Covered Deductible Co-Pay Code Amount Code Amount 03 Gomez, 01/07/20XX 99212 Totals Pedro 132.28 15.00 11.34 158.62 28.55 28.55 Green, 01/04/20XX 99203 Jana 01/04/20XX 71020 Totals Reason Code: 03 Allowed amount per insurance contract 70.92 40.97 111.89 03 03 125.00 15.00 11.34 151.34 28.55 28.55 69.23 34.95 104.18 Amount Amount Paid At 0.00 0.00 0.00 0.00 0.00 0.00 0.00 80% 0.00 80% 0.00 80% 0.00 80% 0.00 0.00 80% 80% 01/20/20XX Payment Amount 100.00 12.00 9.07 121.07 22.84 22.84 55.38 27.96 83.34 Check No: 56390 $227.25 Using the explanation above answer the following questions: 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? Based on the reason code Supplied the charged amount is everything In total, the covered amount is credited to the charged amount in which $131.28-125.00 = 7.28.$ left to pay

FINANCIAL ACCOUNTING
10th Edition
ISBN:9781259964947
Author:Libby
Publisher:Libby
Chapter1: Financial Statements And Business Decisions
Section: Chapter Questions
Problem 1Q
icon
Related questions
Question
100%
J. Explanation of Benefits
XYZ Insurance Company Explanation of Benefits
Walden-Martin Family Medical Clinic
1234 Anystreet
Anytown, AK 12345-1234
Patient Treatment CPT
Name
Dates
Code
Yan, Tai 01/06/20XX (99205
01/06/20XX
01/06/20XX
Totals
Gomez, 01/07/20XX
Pedro
Totals
82947
86580
99212
*
Amount
Charge Reason Covered Deductible Co-Pay
Code Amount Amount Amount Paid At
132.28
03
15.00
11.34
158.62
28.55
28.55
70.92
01/04/20XX 71020
Totals
Green, 01/04/20XX 99203
Jana
40.97
111.89
Reason Code: 03 Allowed amount per insurance contract
03
03
125.00
15.00
11.34
151.34
28.55
28.55
69.23
34.95
104.18
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Copyright © 2020, Elsevier Inc. All Rights Reserved.
80%
80%
80%
0.00 80%
0.00 80%
0.00 80%
01/20/20XX
Payment
Amount
100.00
12.00
9.07
121.07
22.84
22.84
55.38
27.96
83.34
Check No: 56390 $227.25
Using the explanation above answer the following questions:
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?
Based on
on the reason code Supplied the charged amout is everything
In total the covered amount is credited to the charged amount in which
$131.28-125.00 = 7.28.$ left to pay
Transcribed Image Text:J. Explanation of Benefits XYZ Insurance Company Explanation of Benefits Walden-Martin Family Medical Clinic 1234 Anystreet Anytown, AK 12345-1234 Patient Treatment CPT Name Dates Code Yan, Tai 01/06/20XX (99205 01/06/20XX 01/06/20XX Totals Gomez, 01/07/20XX Pedro Totals 82947 86580 99212 * Amount Charge Reason Covered Deductible Co-Pay Code Amount Amount Amount Paid At 132.28 03 15.00 11.34 158.62 28.55 28.55 70.92 01/04/20XX 71020 Totals Green, 01/04/20XX 99203 Jana 40.97 111.89 Reason Code: 03 Allowed amount per insurance contract 03 03 125.00 15.00 11.34 151.34 28.55 28.55 69.23 34.95 104.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Copyright © 2020, Elsevier Inc. All Rights Reserved. 80% 80% 80% 0.00 80% 0.00 80% 0.00 80% 01/20/20XX Payment Amount 100.00 12.00 9.07 121.07 22.84 22.84 55.38 27.96 83.34 Check No: 56390 $227.25 Using the explanation above answer the following questions: 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? Based on on the reason code Supplied the charged amout is everything In total the covered amount is credited to the charged amount in which $131.28-125.00 = 7.28.$ left to pay
368
Chapter 18 Medical Billing and Reimbursement Essentials
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?
K. The Patient's Financial Responsibility
Calculating Coinsurance and Deductible
Use the following information as you answer the following questions.
Patient: Zach Green
Deductible: $750
Coinsurance: 80/20
Patient out-of-pocket expense maximum: $2000
1. During Zach's first visit of the year, he incurred a $500 bill. Who
pays
anteo
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.
prior
the
3. Zach had surgery, which was his third claim of the year. He had a bill of $5000. Considering
visits, what is Zach's portion of this bill and what is the responsibility of the insurance carrier?
Transcribed Image Text:368 Chapter 18 Medical Billing and Reimbursement Essentials 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? K. The Patient's Financial Responsibility Calculating Coinsurance and Deductible Use the following information as you answer the following questions. Patient: Zach Green Deductible: $750 Coinsurance: 80/20 Patient out-of-pocket expense maximum: $2000 1. During Zach's first visit of the year, he incurred a $500 bill. Who pays anteo 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. prior the 3. Zach had surgery, which was his third claim of the year. He had a bill of $5000. Considering visits, what is Zach's portion of this bill and what is the responsibility of the insurance carrier?
Expert Solution
trending now

Trending now

This is a popular solution!

steps

Step by step

Solved in 2 steps

Blurred answer
Follow-up Questions
Read through expert solutions to related follow-up questions below.
Follow-up Question

How did you find out that Tai Yan is responsible for $121.07? Or Jana is responsible for $83.34? Or how it is written off for Jana?

Solution
Bartleby Expert
SEE SOLUTION
Similar questions
  • SEE MORE QUESTIONS
Recommended textbooks for you
FINANCIAL ACCOUNTING
FINANCIAL ACCOUNTING
Accounting
ISBN:
9781259964947
Author:
Libby
Publisher:
MCG
Accounting
Accounting
Accounting
ISBN:
9781337272094
Author:
WARREN, Carl S., Reeve, James M., Duchac, Jonathan E.
Publisher:
Cengage Learning,
Accounting Information Systems
Accounting Information Systems
Accounting
ISBN:
9781337619202
Author:
Hall, James A.
Publisher:
Cengage Learning,
Horngren's Cost Accounting: A Managerial Emphasis…
Horngren's Cost Accounting: A Managerial Emphasis…
Accounting
ISBN:
9780134475585
Author:
Srikant M. Datar, Madhav V. Rajan
Publisher:
PEARSON
Intermediate Accounting
Intermediate Accounting
Accounting
ISBN:
9781259722660
Author:
J. David Spiceland, Mark W. Nelson, Wayne M Thomas
Publisher:
McGraw-Hill Education
Financial and Managerial Accounting
Financial and Managerial Accounting
Accounting
ISBN:
9781259726705
Author:
John J Wild, Ken W. Shaw, Barbara Chiappetta Fundamental Accounting Principles
Publisher:
McGraw-Hill Education