Jody Ehninger is seen in Dr. Ramic's office for a routine diabetic checkup; the doctor also decides to complete some laboratory tests. Jody is insured by Metropolitan Insurance and has a $100 deductible and a 70-30 coinsurance. Dr. Ramic is a participating provider. The following RA is received on February 27. Dzanan Ramic, MD 1529 Cedar Street Allentown, PA 18104 Patient: Jody Ehninger Claim: 19087756345 ID: 098765432 Plan code: P-PAR Med. Rec. No.: 04-JEHN8791 Proc Code From Date Thru Date Treat ment Status Amount Amount Code Charged Allowed Copayl Deduct 99213 02/16 02/16 1 81000 02/16 02/16 80061 02/16 02/16 1 84152 02/16 02/16 1 90471 02/16 02/16 1 1 1 12 10 2 167.00 19.25 261.50 189.00 13.00 84.00 1100 171.00 0.00 9.50 84.00 11.00 5.00 0.00 0.00 Coins Amount Patient Approved Balance 0.00 0.00 0.00 0.00 0.00 0.00 116.20 116.20 49.80 0.00 0.00 0.00 6.65 6.65 2.85 19065 Claim Total 649.75 275.50 100.00 1228 122.5 52.65 10. Explain the claim adjustment reason codes for each procedure. 11. Why is the payer not responsible for coinsurance for procedure codes 99213 and 81000? 12. What amounts are written off for this visit? Why? After receiving a statement and paying her bill in March, Mrs. Ehninger visits the doctor again on May 10; the doctor's fees and the payer's allowed amounts have changed. The charges are for an office visit, 99213, amount charged $172, amount allowed $86; and a urinalysis, 81000, amount charged $20.50, amount allowed $12.75. 13. What is the amount of coinsurance for this visit? 14. What is the amount of write-off for this visit? 15. Complete a ledger card for Jody Ehninger. The RA was received on May 18 and Mrs. Ehninger paid on May 28. Jody Ehninger 23 Lark Lane Allentown, PA 18104 610-555-1516 Metropolitan ID #098765432 Chart #04-JEHN8791 Date/ Pro C harge Payment/Adj Ralne Jody Ehninger is seen in Dr. Ramic's office for a routine diabetic checkup; the doctor also decides to complete some laboratory tests. Jody is insured by Metropolitan Insurance and has a $100 deductible and a 70-30 coinsurance. Dr. Ramic is a participating provider. The following RA is received on February 27. Dzanan Ramic, MD 1529 Cedar Street Allentown, PA 18104 Patient: Jody Ehninger Claim: 19087756345 ID: 098765432 Plan code: P-PAR Med. Rec. No.: 04-JEHN8791 Proc Code From Date Thru Date Treat ment Status Amount Amount Code Charged Allowed Copayl Deduct 99213 02/16 02/16 1 81000 02/16 02/16 80061 02/16 02/16 1 84152 02/16 02/16 1 90471 02/16 02/16 1 1 1 12 10 2 167.00 19.25 261.50 189.00 13.00 84.00 1100 171.00 0.00 9.50 84.00 11.00 5.00 0.00 0.00 Coins Amount Patient Approved Balance 0.00 0.00 0.00 0.00 0.00 0.00 116.20 116.20 49.80 0.00 0.00 0.00 6.65 6.65 2.85 19065 Claim Total 649.75 275.50 100.00 1228 122.5 52.65 10. Explain the claim adjustment reason codes for each procedure. 11. Why is the payer not responsible for coinsurance for procedure codes 99213 and 81000? 12. What amounts are written off for this visit? Why? After receiving a statement and paying her bill in March, Mrs. Ehninger visits the doctor again on May 10; the doctor's fees and the payer's allowed amounts have changed. The charges are for an office visit, 99213, amount charged $172, amount allowed $86; and a urinalysis, 81000, amount charged $20.50, amount allowed $12.75. 13. What is the amount of coinsurance for this visit? 14. What is the amount of write-off for this visit? 15. Complete a ledger card for Jody Ehninger. The RA was received on May 18 and Mrs. Ehninger paid on May 28. Jody Ehninger 23 Lark Lane Allentown, PA 18104 610-555-1516 Metropolitan ID #098765432 Chart #04-JEHN8791 Date/ Pro C harge Payment/Adj Ralne
