Reference no: EM132640042
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:
1. How much money did Dr. Nichols receive?
2. How much should BCBS have paid?
3. How much should Cigna have paid?
4. How much is this claim overpaid?
5. Who overpaid on this claim?
6. 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
What are the main contributors to the gdp
: What are the main contributors to the GDP?
|
Explain economic downturn due to the covid-19 situation
: Interest rates are at historic lows in many countries-in some cases, close to zero. How is expansionary monetary policy
|
Prepare the journal entry to record the capitalization
: Prepare the journal entry to record the capitalization of interest and the recognition of interest expense, if any, at December 31, 2012
|
Determine the labor efficiency variance for march is
: Determine the labor efficiency variance for March is. A total of 19,400 pounds of material were purchased at a cost of $13,580.
|
How the situation might be avoided in the future
: 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.
|
Where does the ethical situation take place
: What are the facts of the case? This should include: what do we need to know, who is involved in the situation, where does the ethical situation take place.
|
Find and identify the parties potentially affected by audit
: Tana Thorne works in a public accounting firm. Identify the parties potentially affected by this audit and the fee plan proposed.
|
Explain why inflation usually accelerated
: Using the concepts aggregate supply and aggregate demand, explain why inflation usually accelerated during wartime?
|
How could people lose faith in money
: Most economist believe that the better fiat money serve as a store of value, the more acceptable it is. What does this mean? How could people lose faith in mone
|