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Walden martin family medical clinic

14/10/2021 Client: muhammad11 Deadline: 2 Day

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:

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