My #6
Danielloyd
hs240_unit6_template.docxKinn’s The Medical Assistant, 13th Edition
Chapter 16: Patient Accounts, Collections, and Practice Management
PROCEDURE 16-1: PERFORM ACCOUNTS RECEIVABLE PROCEDURES FOR PATIENT ACCOUNTS: CHARGES
Scenario 1: Ken Thomas is a returning patient of Dr. Martin. He is being seen for hypertension (ICD-10-CM;I10). He makes his $50 copayment at the time of the office visit.
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BLUE CROSS BLUE SHIELD 1234 Insurance Place Anytown, Anystate 12345-1234 |
Claim Number: |
1-99-16987087 |
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Group Name: |
ABC Company |
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Group Number: |
55124T |
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Employee: |
Ken Thomas |
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Patient: |
Ken Thomas |
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SSN: |
783212215 |
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Prepared by: |
M. Smith |
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James Martin, M.D. |
Prepared on: |
07/04/20XX |
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Walden-Martin Family Medical Clinic |
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1234 Anystreet |
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Anytown, Anystate 12345-1234 |
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PATIENT RESPONSIBILITY |
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Amount not covered: |
0.00 |
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Co-pay amount: |
0.00 |
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Deductible: |
0.00 |
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Coinsurance: |
64.61 |
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Patient’s Total responsibility |
64.61 |
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EXPLANATION OF BENEFITS |
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DOS |
CPT/HCPCS |
Charge Amount |
Not Covered |
Reason Code |
PPO Discount |
Covered Amount |
Ded Amount |
Copay |
Paid at |
Payment Amount |
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06/03/20XX |
99204 |
250.00 |
0.00 |
48 |
136.00 |
114.00 |
0.00 |
0.00 |
80% |
91.20 |
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06/03/20XX |
94375 |
40.00 |
0.00 |
48 |
0.00 |
40.00 |
0.00 |
0.00 |
80% |
32.00 |
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06/03/20XX |
94060 |
75.00 |
0.00 |
48 |
0.00 |
75.00 |
0.00 |
0.00 |
80% |
60.00 |
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06/03/20XX |
94664 |
50.00 |
0.00 |
48 |
0.00 |
75.00 |
0.00 |
0.00 |
80% |
38.76 |
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06/03/20XX |
94760 |
50.00 |
0.00 |
48 |
4.40 |
45.60 |
0.00 |
0.00 |
80% |
36.48 |
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TOTAL |
465.00 |
0.00 |
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141.95 |
323.05 |
0.00 |
0.00 |
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258.44 |
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Total Payment Amount |
258.44 |
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CBT CODE |
Reason Code |
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99204 |
OFFICE/OUTPT VISIT E/M NEW MOD-HI SEVERIT |
48 CON DISCOUNT/PT NOT RESPONSIBLE |
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94375 |
RESPIRATORY FLOW VOLUM LOOP |
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94060 |
BRONCHOSPSM EVAL SPIROM PRE and POST BRON |
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94664 |
AEROSOL/VAPOR FOR INHAL; INT DEMO and EVAL |
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94760 |
NONINVASIVE EAR/PULSE OXIMETRY-02 SAT |
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If you have any questions, call Blue Cross Blue Shield at (800) 255-9091 |
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Ledger:
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Blue Cross Blue Shield |
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ID # KT4496785 |
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Group # 55124T |
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Subscriber: |
Ken Thomas |
Ken Thomas |
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398 Larkin Avenue |
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DOB: |
10/25/1961 |
Anytown, Anystate 12345-1234 |
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Date |
Service Description |
Charges |
Payments |
Adjustments |
Balance |
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06/03/20XX |
99204 |
250.00 |
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250.00 |
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06/03/20XX |
94375 |
40.00 |
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290.00 |
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06/03/20XX |
94060 |
75.00 |
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365.00 |
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06/03/20XX |
94664 |
50.00 |
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415.00 |
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06/03/20XX |
94760 |
50.00 |
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465.00 |
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Ledger Summary:
Scenario 2: Martha Bravo is seeing Dr. Walden for the first time for hypothyroidism (ICD-10-CM; E03.9). She makes the $30 copayment at the time of the office visit.
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Name: |
Martha Bravo |
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Address: |
1234 Anywhere Station Anywhere, Anystate 12345 |
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Contact #1: |
(212) 555-1212 |
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Contact #2: |
(212) 555-1313 |
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Emergency Contact: |
John Bravo (212) 555-2627 |
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SSN: |
111-22-3333 |
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DOB: |
1/23/56 |
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Health Insurance Information: |
Carrier: Aetna Subscriber: Martha Bravo Subscriber DOB: 1/23/56 ID #: XEK3332328748 Group #: X1000 Effective Date: 1/1/20XX |
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Employer Information |
Name: Malibu Gardening Contact: (212) 555-5151 |
Ledger:
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Health Insurance Carrier: |
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ID #: |
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Group #:
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Subscriber: |
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Patient name |
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Address |
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DOB: |
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Date |
Service Description |
Charges |
Payments |
Adjustments |
Balance |
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