These patients are being seen by Dr.Christopher Connolly of Valley Associates,P.C.
A new patient is being seen today by Dr. Christopher Connolly.
His name is Brian Kehoe, and he is insured by a Medicaid managed
care plan. The doctor accepts assignment. His copay is $10, which
he paid today. He is examined in the office today for an abscess on
his mouth, which is not related to any type of accident.
Encounter Form Data
Diagnosis 1 K12.2, abscess of mouth
Procedure Code 99201
Procedure Cost $70
If Medicaid pays 50 percent of the physicians usual charge, after applying the copay, what payment will Medicaid send?
solution:
Total Procedure cost = $70
Co-pay amount = $10
Paying percentage of Medicaid = 50% of physicians Charge
So, total claim amount after co-pay = 70 -10
= $60
Therefore the payment send by Medicaid = 50% of $60
= 0.5 * 60
= $30
These patients are being seen by Dr.Christopher Connolly of Valley Associates,P.C. A new patient is being...
In the cases that follow, you play the role of a medical insurance specialist who is preparing HIPAA claims for transmission. Assume that you are working with the practice’s PMP to enter the transactions. The information you enter is based on the patient information form and the encounter form. • Claim control numbers are created by adding the eight-digit date to the patient account number, as in AA026-10042029. • A copayment of $15 is collected from...
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