Question

Nancy Evans is a 71-year-old female who has been referred to the neurologist because of a possible diagnosis of Alzheimer’s disease. The charges for today total $360.00. Her husband reminds you that she has Medicare and a Medigap plan that picks up her 20% coinsurance after Medicare. You inform Mr. Evans that the office is a participating provider with Medicare. You bill Medicare and find out from the remittance advice (RA) that Nancy has $122.65 left on her deductible for this year.

Discussion Questions:
1. How much of the $360 bill for the neurology consult services will be Nancy’s responsibility? (Refer to the Insurance and Billing chapter if necessary.)

2. What is the best way to bill Nancy for this balance?

3. Why is this way the preferred method?

Answer 1

How much of the $360 bill for the neurology consult services will be Nancy’s responsibility? (Refer to the Insurance and Billing chapter if necessary.)

The billing process contains 6 main steps

a. Patient check into the hospital: in the current scenario neurologist has suggested for Nancy evans check in for possible diagnosis of alzhemiers disease

b. Insurance verification: - Medicare and Medigap

c. Insurance eligibility: - availability is of $122.65

d. Charges 20% of coinsurance

e. Claim submission

122.65 X20%

$24.53

What is the best way to bill Nancy for this balance?

The best way to bill for Nancy is to follow the steps of billing process they are checking insurance eligibility and then claiming insurance, insurance submission followed by payment posting

Why is this way the preferred method?

This way the burden for the patient is reduced and along with that every time the patient checks in there shall be some amount left for him to be utilized.