J. Explanation of BenefitsXYZ Insurance Company Explanation of BenefitsWalden-Martin Family Medical Clinic1234 AnystreetAnytown, AK 12345-1234Patient Treatment CPTNameDatesCodeYan, Tai 01/06/20XX (9920501/06/20XX01/06/20XXTotalsGomez, 01/07/20XXPedroTotals829478658099212*AmountCharge Reason Covered Deductible Co-PayCode Amount Amount Amount Paid At132.280315.0011.34158.6228.5528.5570.9201/04/20XX 71020TotalsGreen, 01/04/20XX 99203Jana40.97111.89Reason Code: 03 Allowed amount per insurance contract0303125.0015.0011.34151.3428.5528.5569.2334.95104.180.000.000.000.000.000.000.000.000.00Copyright © 2020, Elsevier Inc. All Rights Reserved.80%80%80%0.00 80%0.00 80%0.00 80%01/20/20XXPaymentAmount100.0012.009.07121.0722.8422.8455.3827.9683.34Check No: 56390 $227.25Using 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 onon the reason code Supplied the charged amout is everythingIn total the covered amount is credited to the charged amount in which$131.28-125.00 = 7.28.$ left to pay 368Chapter 18 Medical Billing and Reimbursement Essentials2. 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 ResponsibilityCalculating Coinsurance and DeductibleUse the following information as you answer the following questions.Patient: Zach GreenDeductible: $750Coinsurance: 80/20Patient out-of-pocket expense maximum: $20001. During Zach's first visit of the year, he incurred a $500 bill. Whopaysanteothis bill?2. During Zach's second visit of the year, he incurred a $450 bill. Describe how much is paid by Zach andthe insurance carrier.priorthe3. Zach had surgery, which was his third claim of the year. He had a bill of $5000. Consideringvisits, what is Zach's portion of this bill and what is the responsibility of the insurance carrier?

Note: As per our guidelines, we will solve the first question. 1. Yes, there is a difference…

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

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

Pfin (with Mindtap, 1 Term Printed Access Card) (mindtap Course List)

7th Edition

ISBN:9780357033609

Author:Randall Billingsley, Lawrence J. Gitman, Michael D. Joehnk

Publisher:Randall Billingsley, Lawrence J. Gitman, Michael D. Joehnk

Chapter9: Insuring Your Health

Section: Chapter Questions

Problem 8FPE

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