information obtained from RAS through 15.20. Based on the payment in each patient's balance. Claim Case Study 16.5 Patient: Wendy Walker The following information is received on an RA from the Medicare HMO plan The patient made a S10 copay at the time of the visit. PROV PD PROC 99204 ALLOWED 103.00 10.00 93.00 103.00 0.00 Patient balance: Claim Case Study 16.6 Patient: Walter Williams The practice receives the following information on an RA from Aetna Choice. The patient made a $15 copay at the time of the visit. POS PROC BILLED 17.00 COINS/COPAY PROV PD 36415 16.00 0.00 15.00 1.00 atient balance: Claim Case Study 16.7 Patient: Donna Gaeta The nractice receives the following information from Medicare Nationwide 16.2 Handling Denied Claims Claim Case Study 16. Patients: Wendy Walker and Andrea Spinelli 1 The Medicare HMO plan sent the practice an RA as shown in Figure 16.1. Locate the claim for Wendy Walker in the remittance advice (RA). Notice that the claim has been denied. 1. What reason is given for the rejected claim? What procedure has been billed in the claim? (page 485). Does the encounter form contain the same procedure code that What is the date of her signature on the patient information form? Do 2. Refer back to the encounter form for Wendy Walker in Claim Case Study 15 a. Retir nexhto the utin information form for Wend Waler in the same ceas think she is a new or an established patient 4. On checking your files, you confirm that Wendy's visit on October 3 was her first visit to the practice. What procedure code will you use to correct the claim you created for her on 10/03/18 5. In addition to the procedure code, what other item on the claim will you nee to change? (Hint: You may need to refer to Teble 15.1 starting on page 480,) Claim number: 00941108 Dates of service Charge Eligible Patient Amt paid ability provider ame From-thru vid 10/01/18-10/01/18 11 99202 vid 10/01/18 10/01/18 11 81000 1 dy 10/03/18- 10/03/18 11 99214 1 POS Proc Oty amount amount li $50.00 $50.00 $10.00 $40.00 $17.00 $17.00 S 0.00 $17.00 $59.00 -10/06/18 11 99396 1 $106.00 $106.00 $10.00 $96.0 rea 10/06/18-10/06/18 11 69210 1 cedure code. sis is inconsistent with the procedure. $34.00 information obtained from RAS through 15.20. Based on the payment in each patient's balance. Claim Case Study 16.5 Patient: Wendy Walker The following information is received on an RA from the Medicare HMO plan The patient made a S10 copay at the time of the visit. PROV PD PROC 99204 ALLOWED 103.00 10.00 93.00 103.00 0.00 Patient balance: Claim Case Study 16.6 Patient: Walter Williams The practice receives the following information on an RA from Aetna Choice. The patient made a $15 copay at the time of the visit. POS PROC BILLED 17.00 COINS/COPAY PROV PD 36415 16.00 0.00 15.00 1.00 atient balance: Claim Case Study 16.7 Patient: Donna Gaeta The nractice receives the following information from Medicare Nationwide 16.2 Handling Denied Claims Claim Case Study 16. Patients: Wendy Walker and Andrea Spinelli 1 The Medicare HMO plan sent the practice an RA as shown in Figure 16.1. Locate the claim for Wendy Walker in the remittance advice (RA). Notice that the claim has been denied. 1. What reason is given for the rejected claim? What procedure has been billed in the claim? (page 485). Does the encounter form contain the same procedure code that What is the date of her signature on the patient information form? Do 2. Refer back to the encounter form for Wendy Walker in Claim Case Study 15 a. Retir nexhto the utin information form for Wend Waler in the same ceas think she is a new or an established patient 4. On checking your files, you confirm that Wendy's visit on October 3 was her first visit to the practice. What procedure code will you use to correct the claim you created for her on 10/03/18 5. In addition to the procedure code, what other item on the claim will you nee to change? (Hint: You may need to refer to Teble 15.1 starting on page 480,) Claim number: 00941108 Dates of service Charge Eligible Patient Amt paid ability provider ame From-thru vid 10/01/18-10/01/18 11 99202 vid 10/01/18 10/01/18 11 81000 1 dy 10/03/18- 10/03/18 11 99214 1 POS Proc Oty amount amount li $50.00 $50.00 $10.00 $40.00 $17.00 $17.00 S 0.00 $17.00 $59.00 -10/06/18 11 99396 1 $106.00 $106.00 $10.00 $96.0 rea 10/06/18-10/06/18 11 69210 1 cedure code. sis is inconsistent with the procedure. $34.00
