My #6
Kinn’s The Medical Assistant, 13th Edition
Chapter 16: Patient Accounts, Collections, and Practice Management
PROCEDURE 16-1: PERFORM ACCOUNTS RECEIVABLE PROCEDURES FOR PATIENT ACCOUNTS: CHARGES
Scenario 1: Ken Thomas is a returning patient of Dr. Martin. He is being seen for hypertension (ICD-10-CM;I10). He makes his $50 copayment at the time of the office visit.
| BLUE CROSS BLUE SHIELD 1234 Insurance Place Anytown, Anystate 12345-1234 | Claim Number: | 1-99-16987087 | |||||||||||||||||||||
| Group Name: | ABC Company | ||||||||||||||||||||||
| Group Number: | 55124T | ||||||||||||||||||||||
| Employee: | Ken Thomas | ||||||||||||||||||||||
| Patient: | Ken Thomas | ||||||||||||||||||||||
| SSN: | 783212215 | ||||||||||||||||||||||
| Prepared by: | M. Smith | ||||||||||||||||||||||
| James Martin, M.D. | Prepared on: | 07/04/20XX | |||||||||||||||||||||
| Walden-Martin Family Medical Clinic | |||||||||||||||||||||||
| 1234 Anystreet | |||||||||||||||||||||||
| Anytown, Anystate 12345-1234 | |||||||||||||||||||||||
| PATIENT RESPONSIBILITY | |||||||||||||||||||||||
| Amount not covered: | 0.00 | ||||||||||||||||||||||
| Co-pay amount: | 0.00 | ||||||||||||||||||||||
| Deductible: | 0.00 | ||||||||||||||||||||||
| Coinsurance: | 64.61 | ||||||||||||||||||||||
| Patient’s Total responsibility | 64.61 | ||||||||||||||||||||||
| EXPLANATION OF BENEFITS | |||||||||||||||||||||||
| DOS | CPT/HCPCS | Charge Amount | Not Covered | Reason Code | PPO Discount | Covered Amount | Ded Amount | Copay | Paid at | Payment Amount | |||||||||||||
| 06/03/20XX | 99204 | 250.00 | 0.00 | 48 | 136.00 | 114.00 | 0.00 | 0.00 | 80% | 91.20 | |||||||||||||
| 06/03/20XX | 94375 | 40.00 | 0.00 | 48 | 0.00 | 40.00 | 0.00 | 0.00 | 80% | 32.00 | |||||||||||||
| 06/03/20XX | 94060 | 75.00 | 0.00 | 48 | 0.00 | 75.00 | 0.00 | 0.00 | 80% | 60.00 | |||||||||||||
| 06/03/20XX | 94664 | 50.00 | 0.00 | 48 | 0.00 | 75.00 | 0.00 | 0.00 | 80% | 38.76 | |||||||||||||
| 06/03/20XX | 94760 | 50.00 | 0.00 | 48 | 4.40 | 45.60 | 0.00 | 0.00 | 80% | 36.48 | |||||||||||||
| TOTAL | 465.00 | 0.00 | 141.95 | 323.05 | 0.00 | 0.00 | 258.44 | ||||||||||||||||
| Total Payment Amount | 258.44 | ||||||||||||||||||||||
| CBT CODE | Reason Code | ||||||||||||||||||||||
| 99204 | OFFICE/OUTPT VISIT E/M NEW MOD-HI SEVERIT | 48 CON DISCOUNT/PT NOT RESPONSIBLE | |||||||||||||||||||||
| 94375 | RESPIRATORY FLOW VOLUM LOOP | ||||||||||||||||||||||
| 94060 | BRONCHOSPSM EVAL SPIROM PRE and POST BRON | ||||||||||||||||||||||
| 94664 | AEROSOL/VAPOR FOR INHAL; INT DEMO and EVAL | ||||||||||||||||||||||
| 94760 | NONINVASIVE EAR/PULSE OXIMETRY-02 SAT | ||||||||||||||||||||||
| If you have any questions, call Blue Cross Blue Shield at (800) 255-9091 | |||||||||||||||||||||||
Ledger:
| Blue Cross Blue Shield | |||||||||
| ID # KT4496785 | |||||||||
| 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 | ||||||
| 06/03/20XX | 94375 | 40.00 | 290.00 | ||||||
| 06/03/20XX | 94060 | 75.00 | 365.00 | ||||||
| 06/03/20XX | 94664 | 50.00 | 415.00 | ||||||
| 06/03/20XX | 94760 | 50.00 | 465.00 | ||||||
Ledger Summary:
Scenario 2: Martha Bravo is seeing Dr. Walden for the first time for hypothyroidism (ICD-10-CM; E03.9). She makes the $30 copayment at the time of the office visit.
| Name: | Martha Bravo |
| Address: | 1234 Anywhere Station Anywhere, Anystate 12345 |
| Contact #1: | (212) 555-1212 |
| Contact #2: | (212) 555-1313 |
| Emergency Contact: | John Bravo (212) 555-2627 |
| SSN: | 111-22-3333 |
| DOB: | 1/23/56 |
| Health Insurance Information: | Carrier: Aetna Subscriber: Martha Bravo Subscriber DOB: 1/23/56 ID #: XEK3332328748 Group #: X1000 Effective Date: 1/1/20XX |
| Employer Information | Name: Malibu Gardening Contact: (212) 555-5151 |
Ledger:
| Health Insurance Carrier: | |||||||||
| ID #: | |||||||||
| Group #: | |||||||||
| Subscriber: | Patient name | ||||||||
| Address | |||||||||
| DOB: | |||||||||
| Date | Service Description | Charges | Payments | Adjustments | Balance | ||||
Ledger Summary:
