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Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
Edition 7ISBN: 978-1259683077Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
Edition 7ISBN: 978-1259683077 Exercise 26
Completing Correct Claims
The objective of these exercises is to correctly complete private payer claims, applying what you have learned in the chapter. Following the information about the provider for the cases are two sections. The first section contains information about the patient, the insurance coverage, and the current medical condition. The second section is an encounter form for Valley Associates, PC.
Data from the first section, the patient information form, have already been entered in the program for you. You must enter information from the second section, the encounter form, to complete the claim. If you are instructed to use the Medisoft simulation in Connect, follow the steps at the book's website, www.mhhe.com/medisoft to complete the cases at http://connect.mheducation.com on your own once you have watched the demonstration and tried the steps with prompts in practice mode.
If you are gaining experience by completing a paper CMS-1500 claim form, use the blank claim form supplied to you from the back of the book and follow the instructions on pages 249-250 to fill in the form by hand. Alternatively, your instructor may assign the CMS-1500 exercises through Connect, where you can complete the form electronically and submit it to your instructor as part of an assignment.
The following provider information, which is also preloaded in the Medisoft database, should be used for Cases 8.4A and 8.4B on pages 313 and 314, respectively.
Also note the following fee schedule information, which applies to all claim-completion exercises in this and subsequent chapters.
Price Code A: Standard fees, used for all payers except Medicare and Medicaid
Price Code B: Reduced fees, used for Medicare (Medicare Nationwide and Medicare HMO) and Medicaid payers
The amounts shown on the encounter forms in the claim-completion cases are based on Price Codes A and B. Assume that all patient copayments are made at the time of the office visit.
A. Based on the following patient and encounter information, complete a claim for the patient.
B. Based on the following patient and encounter information, complete a claim for the patient.
The objective of these exercises is to correctly complete private payer claims, applying what you have learned in the chapter. Following the information about the provider for the cases are two sections. The first section contains information about the patient, the insurance coverage, and the current medical condition. The second section is an encounter form for Valley Associates, PC.
Data from the first section, the patient information form, have already been entered in the program for you. You must enter information from the second section, the encounter form, to complete the claim. If you are instructed to use the Medisoft simulation in Connect, follow the steps at the book's website, www.mhhe.com/medisoft to complete the cases at http://connect.mheducation.com on your own once you have watched the demonstration and tried the steps with prompts in practice mode.
If you are gaining experience by completing a paper CMS-1500 claim form, use the blank claim form supplied to you from the back of the book and follow the instructions on pages 249-250 to fill in the form by hand. Alternatively, your instructor may assign the CMS-1500 exercises through Connect, where you can complete the form electronically and submit it to your instructor as part of an assignment.
The following provider information, which is also preloaded in the Medisoft database, should be used for Cases 8.4A and 8.4B on pages 313 and 314, respectively.
Also note the following fee schedule information, which applies to all claim-completion exercises in this and subsequent chapters.
Price Code A: Standard fees, used for all payers except Medicare and Medicaid
Price Code B: Reduced fees, used for Medicare (Medicare Nationwide and Medicare HMO) and Medicaid payers
The amounts shown on the encounter forms in the claim-completion cases are based on Price Codes A and B. Assume that all patient copayments are made at the time of the office visit.
A. Based on the following patient and encounter information, complete a claim for the patient.
B. Based on the following patient and encounter information, complete a claim for the patient.
Explanation
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Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
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