Understanding Health Insurance: A Guide to Billing and Reimbursement (MindTap Course List)
14th Edition
ISBN: 9781337554220
Author: Michelle A. Green
Publisher: Cengage Learning
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A patient received $800 medical procedure . The patient has an insurance plan with a 70/30 coinsurance agreement and a $200 deductible which they have not met . The insurance allows $550 on the procedure and the provider will write off the difference in cost . How much will the insurance be responsible for? How much will the patient be responsible for?
Physical locations where health care is provided to patiemts (eg office or other outpatiets settings, hospitals, nursing facilities, home health care or emergency departments the two digit location code is required by medicare
Drag the missing term into each sentence/paragraph text related to completion of the 837 P claim.
The HIPAA 837P uses the term
for the insurance
diagnosis
account
or guarantor, meaning the same as
on the
CMS-1500 clalm.
The name and address of any
than the subscriber or patient who has
is reported if applicable.
party, the entity or person other
responsibility for the bill,
submission
line
filing indicator code is an administrative code used to identify
data
health
the type of
plan, such as a PPO.
and the subscriber are not the same person, an
code is required to specify the patient's relationship
When the
claim
attachment
individual
to the subscriber.
Although sometimes called the patient
number, the claim
number should not be the same as the practice's account
insured
electronic
number for the patient.
The claim
code, also called the claim
financial
policyholder
code, for physician practice claims indicates whether this claim is an original, a
or needs to be voided.
A total of four…
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- The difference between a remittance advice (RA) and an explanation of benefits (EOB) is: The RA goes to the provider only and includes payment information. The EOB goes to the provider. The RA is sent to the patient and includes payment information. The EOB contains payment information.arrow_forwardA request for a patient’s medical record is sent by fax to your office. The fax cover sheet contains the letterhead of a nearby medical facility. You do not recognize the name of the physician, fax number, or telephone number stated for the physician’s office. How do you respond to the request?arrow_forwardA patient receives a $420 medical procedure and has a 70/30 coinsurance agreement and a $100 deductible with their insurance company which they have not met. The insurance allows $300 on the procedure and the provider will write off the difference in cost. How much will the insurance be responsible for? How much will the patient responsible for?arrow_forward
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