Students will complete the following scenario as an essay.
As you are completing your audits you observe Mary Johnson’s chart and notice the following:
Mary Johnson saw Dr. Nichols today for a well-woman exam. Total charges are $185.00. Mary has two insurance companies:
Primary Insurance
Secondary Insurance
BCBS
Cigna Health Care
Copay: $25.00
Deductible: $200.00 (already met)
100% benefit after copay
80% benefit after deductible
Allowed amount: $150.00
Allowed amount: $125.00
Both claims were submitted at the same time in error.
Money collected from the patient: $0.00
- Complete the following questions providing rationales for your responses:
- How much money did Dr. Nichols receive?
- How much should BCBS have paid?
- How much should Cigna have paid?
- How much is this claim overpaid?
- Who overpaid on this claim?
- What would be your next steps?
- Address how this situation might be avoided in the future: be specific and provide steps.
- The well-woman exam showed this patient due to family history of cancer would benefit from BRCA genetic testing and both insurance companies denied this claim. Format a letter of appeal or BRCA testing.
This assignment is completed as an APA style paper, and should be at least 2-3 pages in length. Demonstrate your business knowledge and professional ethics in your response.
Assignment Expectations:
- Length:
- answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 2-3 pages
- Structure:
- Title and reference page required
- address each question in a numbered list
- References:
- References required to be cited if used