Reference no: EM133642302

Overview

A copayment (copay) is a provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider (e.g., physician) for each visit or medical service received (e.g., $20 copayment paid by the patient for evaluation and management services provided during an office visit). Coinsurance is the percentage of costs a patient shares with the health plan (e.g., plan pays 80 percent of costs and patient pays 20 percent or patient pays 20 percent for surgery performed in the office). The reimbursement amount due to the provider for the provision of services includes the amount reimbursed by the payer after the copayment or coinsurance amount is paid by the patient. Any amount remaining is "written off" by the provider. For this activity, the physician is a participating provider (PAR), which means the provider has contracted with the third-party payer and will provide a discount to the patient.

Instructions

Calculate the amounts paid by the payer and the patient and the amount the provider must "write off."

1. The patient is seen by his family physician for follow-up treatment of recently diagnosed asthmatic bronchitis. The physician's fee is $75. The patient's copayment is $20, and the patient is not required to pay any additional amount to the provider. The payer reimburses the physician $28.

A. Enter the amount the patient pays the provide?

B. Enter the amount the prayer reimburses the provide.?

C. Enter the amount the provider "writes off" the amount.?

2. The patient undergoes chemical ablation of one facial lesion in the physician's office. The physician's fee is $240. The patient's copayment is $18, and the patient is not required to pay any additional amount to the provider. The payer reimburses the physician $105.

A. Enter the amount the patient pays the provider:

B. Enter the amount the payer reimburses the provider.?

C. Enter the amount the provider "writes off" the account.?