Health Insurance Calculations – Medicare Non-Participating Provider
This scenario is for a non-participating provider who contracts with Medicare. Prior to determining the limiting charge, you must first decrease the PFS amount by 5%. More information is available to you in Chapter 9 of your text, pages 322-330. Use the attached document to complete and submit for grading.
Consider Frank Serpico, New York City Police Detective (Retired).
In the 1970’s, Detective Serpico “broke the ranks” and exposed police corruption in the New York City Police Department. As a result, he was shot in the face, and it is his belief that he was set up by his colleagues — officers charged with the protection of the citizenry. Do you believe the subculture […]
Effectively Using the Electronic Remittance Advice
The remittance advice is a key document that reimbursement specialists use daily on the job. This document, whether in an electronic or paper form, provides essential information that helps us to effectively perform the job duty of applying insurance reimbursement to patient financial accounts. Illustrate your knowledge of the components and use of the electronic […]
Dissecting the CMS 1500 Claim Form
There are many important details that are entered on a CMS 1500 claim form for a patient’s services that were rendered by a provider. Information added to the claim form is electronically captured within the practice management system and electronic health record that is used by the medical office. Medical coders and reimbursement specialists are […]
Assign the appropriate CPT E & M level, procedures and ICD-10-CM code(s) for the physician office encounter
Assign the appropriate CPT E & M level, procedures and ICD-10-CM code(s) for the physician office encounter. When there are multiple CPT codes, always sequence E & M level first. When there are multiple ICD-10-CM codes, sequence first-listed diagnosis first. This patient was referred by her primary care physician due to complaints of muscle weakness […]