PROCEDURE 16-2. PERFORM ACCOUNTS RECEIVABLE PROCEDURES IN PATIENT ACCOUNTS: PAYMENTS AND ADJUSTMENTS MAERBICAAHEP COMPETENCIES: VIII.P.1. ABHES COMPETENCIES: 8.5.1., 8.b.2. TASK: Process payments and adjustments to patient account records accurately. EQUIPMENT AND SUPPLIES Patient account ledger card or SimChart for the Medical Office software Explanation of benefits Standards: Complete the procedure and all critical steps in minutes with a minimum score of 85% within three attempts. Scoring: Divide the points earned by the total possible points. Failure to perform a critical step, indicated by an asterisk *), results in an unsatisfactory overall score. Time began Time ended Total minutes: Attempt Attempt Attempt Possible Points Steps Posting Payments and Adjustments Manually 1. Review the EOB for multiple patient accounts received by the healthcare facility. 2. Look up the ledger card for the patient account (or the patient ledger in SimChart) 3. Post the payment and adjustment line by line. Posting Payments and Adjustments in SimChart 1. After one line on the EOB has been posted, post all subsequent lines on the EOB separately. 2. Confirm that the adjustment was necessary on the EOB. Review the amount paid. If there is concem that the amount adjusted was too much, either review the provider's contract with the insurance company's fee schedule to compare payments, or call the insurance company's provider services to inquire about the applicable adjusted amount. 3. When the patient's financial responsibility has been established, send the patient a statement. The secondary insurance should be billed if the patient is covered. 91022 91092 noq oldizzoq 000 + ungle 'obal Capit 2017 , NG and Man Chat 16 Patie Adu, ale Ledger Blue Cross Blue Shield ID #KT4496785 S LEST MESTO tuen EST wolna Group #55124T Subscriber: Ken Thomas Ken Thomas 398 Larkin Avenue DOB: 10/25/1961 Anytown, Anystate 12345-1234 Date Service Description Charges Payments Adjustments Balance 06/03/20xx 99204 250.00 250.00 94375 40.00 290.00 94060 75.00 365.00 06/03/20XX 06/03/20XX 06/03/20XX 06/03/20xx 94664 50.00 415.00 94760 50.00 465. 000 Claim Number: Group Name: Group Number: 1-99-16987087 ABC Company 55124T BLUE CROSS BLUE SHIELD 1234 Insurance Place Anytown, Anystate 12345-1234 Employee: Patient: SSN Prepared by Prepared on: Ken Thomas Ken Thomas 783212215 M. Smith 07/04/20xx James Martin, M.D. Walden-Martin Family Medical Clinic 1234 Anystreet Anytown, Anystate 12345-1234 PATIENT RESPONSIBILITY Amount not covered: Co-pay amount: Deductible: Coinsurance: Patient's total responsibility 0.00 0.00 0.00 64,61 64.61 EXPLANATION OF BENEFITS Charge Not Reason CPT/HCPCS Amount Covered Code DOS PPO Covered Ded Discount Amount Amount Paid Payment at Amount 99204 06/03/20xx 06/03/20 x 250.00 0.00 40,000.00 48 48 94375 136.00 0.00 0.00 114.00 40.00 75.00 0.00 0.00 0.00 0.00 0.00 0.00 80% 80% 80% 91.20 32.00 60,00 48 1.55 48.45 0.00 0.00 80% 38.76 06/03/20 94060 06/03/2006 94864 06/03/20 x 94760 TOTAL 75.000.00 50,000.00 50.00 0.00 465.000 .00 48 80% 4 .40 1141 96 45.60 323.05 0.00 0.00 0.00 0. 00 36.48 58 44 2 Total Payment Amount 258.44 Reason Code 48 CON DISCOUNT/PT NOT RESPONSIBLE CPT Code 99204 OFFICE OUTPT VISIT EMNEW MOD HI SEVERIT 94375 RESPIRATORY FLOW VOLUM LOOP 94000 BRONCHOSPSM EVAL SPIROM PRE and POST BRON 94664 AF ROSOL VAPOR FOR INHALA: INT DEMO and EVAL 94760 NONINVASIVE EARUPULSE OXIMETRY-02 SAT you have any questions, call Blue Cross Blue Shield at (800) 255-9091 PROCEDURE 16-2. PERFORM ACCOUNTS RECEIVABLE PROCEDURES IN PATIENT ACCOUNTS: PAYMENTS AND ADJUSTMENTS MAERBICAAHEP COMPETENCIES: VIII.P.1. ABHES COMPETENCIES: 8.5.1., 8.b.2. TASK: Process payments and adjustments to patient account records accurately. EQUIPMENT AND SUPPLIES Patient account ledger card or SimChart for the Medical Office software Explanation of benefits Standards: Complete the procedure and all critical steps in minutes with a minimum score of 85% within three attempts. Scoring: Divide the points earned by the total possible points. Failure to perform a critical step, indicated by an asterisk *), results in an unsatisfactory overall score. Time began Time ended Total minutes: Attempt Attempt Attempt Possible Points Steps Posting Payments and Adjustments Manually 1. Review the EOB for multiple patient accounts received by the healthcare facility. 2. Look up the ledger card for the patient account (or the patient ledger in SimChart) 3. Post the payment and adjustment line by line. Posting Payments and Adjustments in SimChart 1. After one line on the EOB has been posted, post all subsequent lines on the EOB separately. 2. Confirm that the adjustment was necessary on the EOB. Review the amount paid. If there is concem that the amount adjusted was too much, either review the provider's contract with the insurance company's fee schedule to compare payments, or call the insurance company's provider services to inquire about the applicable adjusted amount. 3. When the patient's financial responsibility has been established, send the patient a statement. The secondary insurance should be billed if the patient is covered. 91022 91092 noq oldizzoq 000 + ungle 'obal Capit 2017 , NG and Man Chat 16 Patie Adu, ale Ledger Blue Cross Blue Shield ID #KT4496785 S LEST MESTO tuen EST wolna Group #55124T Subscriber: Ken Thomas Ken Thomas 398 Larkin Avenue DOB: 10/25/1961 Anytown, Anystate 12345-1234 Date Service Description Charges Payments Adjustments Balance 06/03/20xx 99204 250.00 250.00 94375 40.00 290.00 94060 75.00 365.00 06/03/20XX 06/03/20XX 06/03/20XX 06/03/20xx 94664 50.00 415.00 94760 50.00 465. 000 Claim Number: Group Name: Group Number: 1-99-16987087 ABC Company 55124T BLUE CROSS BLUE SHIELD 1234 Insurance Place Anytown, Anystate 12345-1234 Employee: Patient: SSN Prepared by Prepared on: Ken Thomas Ken Thomas 783212215 M. Smith 07/04/20xx James Martin, M.D. Walden-Martin Family Medical Clinic 1234 Anystreet Anytown, Anystate 12345-1234 PATIENT RESPONSIBILITY Amount not covered: Co-pay amount: Deductible: Coinsurance: Patient's total responsibility 0.00 0.00 0.00 64,61 64.61 EXPLANATION OF BENEFITS Charge Not Reason CPT/HCPCS Amount Covered Code DOS PPO Covered Ded Discount Amount Amount Paid Payment at Amount 99204 06/03/20xx 06/03/20 x 250.00 0.00 40,000.00 48 48 94375 136.00 0.00 0.00 114.00 40.00 75.00 0.00 0.00 0.00 0.00 0.00 0.00 80% 80% 80% 91.20 32.00 60,00 48 1.55 48.45 0.00 0.00 80% 38.76 06/03/20 94060 06/03/2006 94864 06/03/20 x 94760 TOTAL 75.000.00 50,000.00 50.00 0.00 465.000 .00 48 80% 4 .40 1141 96 45.60 323.05 0.00 0.00 0.00 0. 00 36.48 58 44 2 Total Payment Amount 258.44 Reason Code 48 CON DISCOUNT/PT NOT RESPONSIBLE CPT Code 99204 OFFICE OUTPT VISIT EMNEW MOD HI SEVERIT 94375 RESPIRATORY FLOW VOLUM LOOP 94000 BRONCHOSPSM EVAL SPIROM PRE and POST BRON 94664 AF ROSOL VAPOR FOR INHALA: INT DEMO and EVAL 94760 NONINVASIVE EARUPULSE OXIMETRY-02 SAT you have any questions, call Blue Cross Blue Shield at (800) 255-9091