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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
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