Using critical thinking skills, play the role of an administrative medical assistant as answer each question in full sentences How would you explain to a patient who is unfamiliar with insurance terminology what is meant by the term third party payer How was the term derived Ellen Gold, a Medicare patient, does not understand her last month's medical statement She already paid her deductible, yet the bill states that she owes $20 on a total bill of $100 How would you explain the bill to her Joe Cantinori inquires about his unpaid bill and asks whether the physician received payment from his insurance company When you check his record, you find that your office submitted the insurance form on his behalf However, the physician did not accept assignment on the claim, since he is not a PAR provider in that program This means that the insurance company will send the payment directly to Joe How would you explain this to Joe A patient complained of symptoms usually associated with arthritis The physician ordered the following tests rheumatoid factor, uric acid, sedimentation rate, and fluorescent non infectious agent screening The insurance claim submitted contained procedure codes for each test You have not received any response from the insurance carrier, even though payments for other claims sent to the same carrier on that day have been received What do you think accounts for the delay Wayne Elliot asks you why he was charged for two office visits when his daughters, Emily and Rose, were seen at the same time in the same room for the same probleman earache Explain the reasoning behind the charges You receive an EOB for a patient who is covered by an HMO The HMO did not pay for services received on May 5, which is when the patient visited Dr Larsen for her annual Pap smear You check your records and find that the same insurance carrier paid for previous Pap smears for the same patient in past years What should you do You receive an ERA from Blue Cross Blue Shield for a Medicare patient The amount received for the claim is $60, which is $20 less than the usual fee of $80 Since the doctor you work for accepts assignment for Medicare patients, the medical practice will need to write off this amount You decide to delete the initial fee of $80 in the computerized patient ledger and key in $60 so that the account balances Why is this a mistake You notice that an elderly patient is scheduled for a minor surgical procedure that will remove unsightly dark patches of skin, a procedure that is considered cosmetic by most insurance companies Why is it a good idea to point this out to the patient before the procedure

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Using critical-thinking skills, play the role of an administrative medical assistant as answer each question in full sentences.

How would you explain to a patient who is unfamiliar with insurance terminology what is meant by the term third-party payer? How was the term derived?
Ellen Gold, a Medicare patient, does not understand her last month's medical statement. She already paid her deductible, yet the bill states that she owes $20 on a total bill of $100. How would you explain the bill to her?
Joe Cantinori inquires about his unpaid bill and asks whether the physician received payment from his insurance company. When you check his record, you find that your office submitted the insurance form on his behalf. However, the physician did not accept assignment on the claim, since he is not a PAR provider in that program. This means that the insurance company will send the payment directly to Joe. How would you explain this to Joe?
A patient complained of symptoms usually associated with arthritis. The physician ordered the following tests: rheumatoid factor, uric acid, sedimentation rate, and fluorescent non-infectious agent screening. The insurance claim submitted contained procedure codes for each test. You have not received any response from the insurance carrier, even though payments for other claims sent to the same carrier on that day have been received. What do you think accounts for the delay?

Wayne Elliot asks you why he was charged for two office visits when his daughters, Emily and Rose, were seen at the same time in the same room for the same probleman earache. Explain the reasoning behind the charges.
You receive an EOB for a patient who is covered by an HMO. The HMO did not pay for services received on May 5, which is when the patient visited Dr. Larsen for her annual Pap smear. You check your records and find that the same insurance carrier paid for previous Pap smears for the same patient in past years. What should you do?
You receive an ERA from Blue Cross Blue Shield for a Medicare patient. The amount received for the claim is $60, which is $20 less than the usual fee of $80. Since the doctor you work for accepts assignment for Medicare patients, the medical practice will need to write off this amount. You decide to delete the initial fee of $80 in the computerized patient ledger and key in $60 so that the account balances. Why is this a mistake?
You notice that an elderly patient is scheduled for a minor surgical procedure that will remove unsightly dark patches of skin, a procedure that is considered cosmetic by most insurance companies. Why is it a good idea to point this out to the patient before the procedure?