Start by reading and following these instructions:
- Quickly skim the questions or assignment below and the assignment rubric to help you focus.
- Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
- Consider the discussion and the any insights you gained from it.
- Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.
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:
Cigna Health Care
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
- 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?
- 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 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.
- File name: