Medical Insurance - Math

Can earn RHIA or RHIT certification; work in office practices, nursing homes, home health agencies, & public health agencies

Health information certificate

What type of health plan is described: HMO, PPO, or Indemnity

PPO

What is the annual premium?

W

The patient is enrolled in a capitated HMO with a $10 copayment for primary care physician visits and no coinsurance requirements. After collecting $10 from the patient, what amount can the medical insurance specialist bill the payer for an office visit?

$0

What is the annual deductible?

$2,500

The patient's coinsurance percentage is stated as 80-20 in the insurance policy. The deductible for the year has been met. If the visit charges are $420, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed?

$336 ins; $84 patient

The patient's coinsurance percentage is stated as 75-25 in the insurance policy. The deductible for the year has been met. If the visit charges are $1,000, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed?

$750 ins; $250 patient

The patient's health plan has a $100 annual deductible. At the first visit of the year, the charges are $95. What does the patient owe?

$95

Can earn the title CMA or RMA

Medical assisting certifiaction

Steps of the Medical Billing Cycle

Preregister patients establish financial responsibility check in patients review coding compliance review billing compliance check out patients prepare and transmit claim monitor payer adjudication generage patient statement follow up payments & collect

Experts in classifying medical data, inlcudes CCA, CCS, CCS-P, CPC, CPC-H, CPC-P, CPC-H certifiacate

coding certification

REquired by most professional organizations

continuing education