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 From Thru Treat- Status Amount Amount Copay/ Coins Amount Patient Apprvd Balance Code Date Date ment Code Chrgd Allwd Deduct 99213 02/16 02/16 1 81000 02/16 02/16 1 80061 02/16 02/16 1 84152 02/16 02/16 1 90471 02/16 02/161 167.00 84.00 84.00 0.00 0.00 0.00 19.25 11.00 11.00 0.00 1 0.00 0.00 1,2 261.50 171.00 5.00 116.20 116.2049.80 10 189.00 0.00 0.00 0.00 0.00 2 13.00 9.50 0.00 6.65 6.65 0.00 2.85 90658 Claim Totals 649.75 275.50 100.00 122.85 122.85 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. 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 From Thru Treat- Status Amount Amount Copay/ Coins Amount Patient Apprvd Balance Code Date Date ment Code Chrgd Allwd Deduct 99213 02/16 02/16 1 81000 02/16 02/16 1 80061 02/16 02/16 1 84152 02/16 02/16 1 90471 02/16 02/161 167.00 84.00 84.00 0.00 0.00 0.00 19.25 11.00 11.00 0.00 1 0.00 0.00 1,2 261.50 171.00 5.00 116.20 116.2049.80 10 189.00 0.00 0.00 0.00 0.00 2 13.00 9.50 0.00 6.65 6.65 0.00 2.85 90658 Claim Totals 649.75 275.50 100.00 122.85 122.85 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
