week 4 quay

Student instructions

1. If you have questions about this activity, please contact your instructor for assistance.

2. You will review the chart of Liu Huang to complete this activity. Your instructor has provided you with a link to the Posting Payments and Adjustments activity. Click on Launch EHR to review the patient chart and begin this activity.

3. Refer to the patient chart and any suggested resources to complete this activity.

4. You will complete documentation in EHR Go as instructed below. When you complete this activity, you will download your Progress Report in EHR Go under 3: Download Work, save the Progress Report to your device, and then upload the Progress Report to your Learning Management System (LMS). 

Suggested resources

1. Review the guide below found under Help/Guides on ehrgo.com:

· EHR Go Guide to Claims and Ledgers

Glossary

Allowed Charges: The maximum amount a plan will pay for a covered health care service.

Coinsurance: The percentage of covered costs for healthcare services that a patient is required to pay after the patient has paid their deductible.

Deductible: The amount a patient must pay for covered health care services before their insurance plan begins to pay.

Provider Charges: The amount a provider charges for services, which can sometimes exceed the allowed charges set by the patient’s insurance company.

(HealthCare.gov)

The activity

Liu Huang was seen for an outpatient visit at the Central Clinic and received a glenohumeral joint injection during the appointment. A claim was created for this visit and procedure and submitted to Liu’s insurance company. The insurance company provided Central Clinic with the below Explanation of Benefits (EOB) indicating what they covered, and they also submitted payment for their share through Electronic Fund Transfer (EFT). Review the submitted claim under the Account section of Liu’s chart. Then update the ledger to indicate the insurance adjustments and payments.

Additional info

Liu has met his annual deductible. Any Provider Charges that exceed the insurance company’s Allowed Charges were discounted and adjusted by the insurance company – neither the insurance company or the patient will be responsible for any amount exceeding the Allowed Charges in this situation and the provider will not receive payment for this amount. The insurance company then pays 80% of the Allowed Charges, and the remaining 20% is Liu’s responsibility as coinsurance.

The Discounts can be entered as adjustment transactions from the insurance company as a credit without a balance transfer.

The amounts Paid by Insurer can be added as payor payments via EFT.

The amounts owed by Liu as Patient Responsibility can be entered as an adjustment with a transfer balance from the insurance company to the patient. The transaction is for a credit for Patient Responsibility: Coinsurance.

References

HealthCare.gov. (n.d.). Glossary. Retrieved from https://www.healthcare.gov/glossary/