Chat with AI
Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
Edition 7ISBN: 978-1259683077Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
Edition 7ISBN: 978-1259683077 Exercise 24
Calculating Insurance Math
In order to complete the service line information on claims when units of measure are involved, insurance math is required. For example, this is the HCPCS description for an injection of the drug Eloxatin:
J9263 oxaliplatain, 0.5 mg
If the physician provided 50-mg infusion of the drug, instead of an injection, the service line is
J9263 × 100
to report a unit of 50 (100 × 0.05 mg = 50). What is the unit reported for service line information if a 150-mg infusion is provided?
Abstracting Insurance Information
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 PORCEJE0-01012016.
• A copayment of $15 is collected from each Oxford PPO patient at the time of the visit. A copayment of $10 is collected for Oxford HMO.
Note: For these case studies, do not subtract the copayment from the charges; the payer's allowed fees have already been reduced by the amount of the copayment.
• The practice uses NDC as its clearinghouse to transmit claims.
• The necessary data for the payer and the clearinghouse are stored in the program's databases.
In order to complete the service line information on claims when units of measure are involved, insurance math is required. For example, this is the HCPCS description for an injection of the drug Eloxatin:
J9263 oxaliplatain, 0.5 mg
If the physician provided 50-mg infusion of the drug, instead of an injection, the service line is
J9263 × 100
to report a unit of 50 (100 × 0.05 mg = 50). What is the unit reported for service line information if a 150-mg infusion is provided?
Abstracting Insurance Information
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 PORCEJE0-01012016.
• A copayment of $15 is collected from each Oxford PPO patient at the time of the visit. A copayment of $10 is collected for Oxford HMO.
Note: For these case studies, do not subtract the copayment from the charges; the payer's allowed fees have already been reduced by the amount of the copayment.
• The practice uses NDC as its clearinghouse to transmit claims.
• The necessary data for the payer and the clearinghouse are stored in the program's databases.
Explanation
This question doesn’t have an expert verified answer yet, let Quizplus AI Copilot help.
Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby
Why don’t you like this exercise?
Other Minimum 8 character and maximum 255 character
Character 255
