General Category > General Questions

Check my Answers

(1/2) > >>

jerrywrose:
Was wondering if someone could review these billing problems and tell me if I did them correctly.

Calculate the amount due from the insurance carrier and the amount due from the patient for the following examples (please show your calculations):

Insurance contract – Carrier One      
Pays 100% 1st procedure, 50% all others
Grouper rates:         
1   300      
2   500
3   600
4   700

Insurance Contract – Carrier Two
Pays 70% of billed charges

Example 1
Patient has Carrier One as their insurance, a 20% co-insurance amt, and has met $100.00 of their $500.00 deductible
The following charges were submitted:
Cpt code – 29881 – group 4, charges are 4250.00
Cpt code – 29877 – group 4, charges are 5000.00
Cpt code – 75006 – group 1, charges are  500.00


Assumptions:
1. Carrier One is primary insurance and will pay first
2. Carrier Two is secondary insurance.

Calculations
1.For CPT Code 29881
a.Contract rate is $700, patient has $400 left on deductible so this leaves $300 to be applied to Carrier One. Patient pays co-insurance amount of $60 ($300 x 20%) and Carrier One will pay 100% of $240.
b.Since patient was billed $460 (amount of deductible plus co-insurance), Carrier Two will pay $322 ($460 x 70%). This leaves $138 for the patient.

2. For CPT Code 29877
a. Patient deductible for Carrier One has been met through the previous procedure. Contract rate is $700. Patient has co-insurance amount of $140 ($700 x 20%) leaving $560. Carrier One will now pay $280 ($560 x 50%).
b. Since the patient was billed for $420 ($140 co-insurance + $280 50% amount), Carrier Two will pay $294 ($420 x 70%). This leaves $126 ($420-$294) for the patient.

3. For CPT Code 75006
a. Patient deductible for Carrier One has been met through the previous procedure. Contract rate is $300. Patient has co-insurance amount of $60 ($300 x 20%) leaving $240. Carrier One will now pay $120 ($240 x 50%).

b. Since the patient was billed for $180 ($60 co-insurance + $120 50% amount), Carrier Two will pay $126 ($180  x 70%). This leaves $54 ($180-$126) for the patient.


Example 2

Patient has Carrier Two as their insurance, a $100.00 co-pay, and has not met their $500.00 deductible
The following charges were submitted:
Cpt code – 62311 – group 1, charges are $1700.00
Cpt code – 64590 – group 2, charges are $2300.00

1. For CPT Code 62311
a. Contract rate is $300. Since the patient has not met any of their $500 deductible, they are responsible for the full amount of $300.
b. Carrier Two pays nothing

2. For CPT Code 64590
a. Contract rate is $500. Patient has $200 of deductible left plus $100 co-pay so the amount applied to Carrier Two is $140 (($500-$200 deductible - $100 co-pay) x 70%). Patient will pay $360 (remaining $200 deductible amount + $100 co-pay + 30% of $200).


Thank you,

Jerry

Merry:
Sounds like a homework assignment or an exam. Should we REALLY be doing this. Don't want to deny anyone help but...

jerrywrose:
It's not formal homework or part of an exam. I'm trying to teach myself medical billing. I bought a book on this site called "The Basics of Medical Billing" and read it. However, there weren't any practical application problems. So I did a google search and found some problems, but no answer key. I worked the problems on my own and just want to know if I did them correctly. Not tryng to get over on anyone.  Just don't have a lot of of money to attend  formal classes

Thanks,

Jerry

PMRNC:
I think it's more beneficial to you to work through learning billing in a better way. I'm sorry but A "BASIC HOW TO" is not a good way to learn this business. Remember that this is the second largest government regulated industry in the world only second to banking. YOU do NOT want to learn from a book.
Not trying to be harsh but you need formal training and education.

jerrywrose:
I appreciate your input, but the email I got when I puchased the book said I could get help here. That really isn't helping me.

Was the offer of help just an empty promise so I would buy a book?

Integrity check time.

Jerry

Navigation

[0] Message Index

[#] Next page