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{"id":201824,"date":"2022-04-24T05:07:33","date_gmt":"2022-04-24T05:07:33","guid":{"rendered":"https:\/\/nursingwritershelp.com\/?p=201824"},"modified":"2022-04-24T05:07:33","modified_gmt":"2022-04-24T05:07:33","slug":"3255-9","status":"publish","type":"post","link":"https:\/\/nursingwritershelp.com\/3255-9\/","title":{"rendered":"3255"},"content":{"rendered":"\u00a0<\/p>\n
Students will complete the following scenario as an essay.<\/p>\n
As you are completing your audits you observe Mary Johnson\u2019s chart and notice the following:<\/p>\n
Mary Johnson saw Dr. Nichols today for a well-woman exam. Total charges are $185.00. Mary has two insurance companies:<\/p>\n
Primary Insurance<\/p>\n
Secondary Insurance<\/p>\n
BCBS<\/p>\n
Cigna Health Care<\/p>\n
Copay: $25.00<\/p>\n
Deductible: $200.00 (already met)<\/p>\n
100% benefit after copay<\/p>\n
80% benefit after deductible<\/p>\n
Allowed amount: $150.00<\/p>\n
Allowed amount: $125.00<\/p>\n
Both claims were submitted at the same time in error.<\/p>\n
Money collected from the patient: $0.00<\/p>\n
\n- Complete the following questions providing rationales for your responses:\n
\n- How much money did Dr. Nichols receive?<\/li>\n
- How much should BCBS have paid?<\/li>\n
- How much should Cigna have paid?<\/li>\n
- How much is this claim overpaid?<\/li>\n
- Who overpaid on this claim?<\/li>\n
- What would be your next steps?<\/li>\n<\/ol>\n<\/li>\n
- Address how this situation might be avoided in the future: be specific and provide steps.<\/li>\n
- 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.<\/li>\n<\/ol>\n
This assignment is completed as an APA style paper, and should be at least 2-3\u00a0pages in length. Demonstrate your business knowledge and professional ethics in your response.<\/p>\n
Assignment Expectations:\u00a0\u00a0<\/em><\/p>\n\n- Length:\n
\n- answers must thoroughly address each question in a clear, concise manner; complete answers will likely take\u00a02-3 pages<\/li>\n<\/ul>\n<\/li>\n
- Structure:\n
\n- Title and reference page required<\/li>\n
- address each question in a numbered list<\/li>\n<\/ul>\n<\/li>\n
- References:\n
\n- References required to be cited if used<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n \n