13.2

what is gloria ramirezs balance due for the two dates of service lised?

Kurt Jugals first visit of the year is the encounter shown for DOS 2/16/2018. What is the patients deductible under plan R-1? (hint: because the deductible was satisfied by the patient payment for the first charge, he payment was made up of the deductible and the coinsurance under the plan.)

451 Case 13.2 Calculating Insurance Math Claim Patient Payment Adjustment Patient Date of Provider Allowed (Coinsurance and Reason PROV tID Name Plan Service Procedure Charge AmountDeductible) Code PAY $59.00 $8.85 2 $50.15 537-88-5267 Ramirez, R-1 02/13/2018- 99214 $105.60 Gloria B 2/13/2018 7 Finucula, R1 01/15/2018-99292$88.00 $50.00 $7.50 $42.50 Betty R 1/15/2018 537-88-5267 Ramirez, R-1 02/14/2018-90732$38.00 $38.00 49 0 Gloria B. 2/14/2018 12 $121.85 $87.55 S12480 R-1 02/16/2018- 93975 $580.00 $261.00 $139.15 $15.45 760-57-5372 Jugal Kurt T 2/16/2018 99204 ! $178.00 |$103.00 875-17-0098 Quan, PPO-3 02/16/2018- 20005 $192.00 $156.00 2/16/2018 $31.20 2 Mary K TOTAL $426.85 The preceding RA has been received by a provider A. LO 13.5 What is the patient coinsurance percentage required under plan R-1? B. LO 13.5 What is the patient coinsurance percentage required under plan PPO-3? C. LO13.5 What is Gloria Ramirez's balance due for the two dates of service listed? D. LO13.5 Kurt Jugal's first visit of the year is the encounter shown for DOS 2/16/2018. What is the patient's deductible under plan R-1? (Hint: Because the deductible was satisfied by the patient's payment for the first charge, that payment was made up of the deductible and the coinsurance under the plan.) Case 13.3 Using Insurance Terms Read this information from a Medicare carrier and answer the questions that follow E&M services rendered in a private residence are correctly billed with CPT codes 99341-99345 (new patients) and CPT codes 99347-99350 (established patients), home services. These CPT codes are payable only in home settings, that is, place of service 12. National Government Services has seen many instances of providers billing outpatient/office codes in home settings. Home visits should not be reported with E&M codes 99201-99215, which represent office and outpatient services. A. LO 13.3 Based on Table 13.2, what claim adjustment reason code will result if this code is billed 99201, POS 12? B. LO 13.3 Which Remark Code would appear, N210 or N211