Define how the situation might be avoided in the future

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Reference no: EM132683306

Assignment: 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

1. 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?

2. Address how this situation might be avoided in the future: be specific and provide steps.

3. 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.

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.

Reference no: EM132683306

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