A patient received services on April 5, totaling $1,000. He paid a $90 coinsurance at the time services were rendered. (The payer required the patient to pay a 20 percent coinsurance of the reasonable charge at the time services were provided.) The physician accepted assignment, and the insurance company established the reasonable charge as $450. On July 1, the provider received $360 from the insurance company. On August 1, the patient received a check from the insurance company in the amount of $450. The overpayment was _____, and the _____ must reimburse the insurance company. (Remember! Coinsurance is the percentage of costs a patient shares with the health plan.) Show
1) $640, physician The four stages of the life cycle of an insurance claim are: 1) Payment, submission, posting, processing Recommended textbook solutions
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Mathematics with Business Applications6th EditionMcGraw-Hill Education 3,760 solutions Business Math17th EditionMary Hansen 3,644 solutions Business Math17th EditionMary Hansen 3,644 solutions Mathematics with Business Applications6th EditionMcGraw-Hill Education 3,760 solutions Which means the that the patient and or insured has authorized the payer to reimburse the provider directly?assignment of benefits. Which means that the patient and/or insured has authorized the payer to reimburse the provider directly? Medicare Summary Notice.
Which is a characteristic of delinquent commercial claims awaiting payer reimbursement quizlet?Verify health plan identification information on all patients. Which is a characteristic of delinquent commercial claims awaiting payer reimbursement? The delinquent claims are resolved directly with the payer.
Which of these is the system by which payers deposit funds to the provider's account electronically?An electronic funds transfer, or EFT, is the electronic message used by health plans to order a financial institution to electronically transfer funds to a provider's account to pay for health care services. An EFT includes information such as: Amount being paid. Name and identification of the payer and payee.
What is the process used by payers to review claims before they are processed quizlet?The adjudication process is made up of five steps designed to judge how it should be paid: (1) initial processing; (2) automated review; (3) manual review; (4) determination; and (5) payment. Each claim's data elements are checked by the payer's front-end claims processing system.
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Which means that the patient and or insured has authorized the payer to reimburse the provider directly quizlet?
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