ASSIGNMENT 6.2 CALCULATE MATHEMATICAL PROBLEMS

Performance Objective

Task: Calculate and insert the correct amounts for nine Medicare scenarios.

Conditions: Use a pen or pencil and the de scription of the problem.

Directions: Submitting insurance claims, particularly Medicare claims, involves a bit of arithmetic. Several problems are given here so that you will gain experience with situation s encountered daily in your work. The Medicare deductible is always subtracted from the allowed amount first before mathematical computations continue.

 

Problem 1: Mr. Doolittle has Medicare Parts A and B coverage. He was well during the entire past year. On January 1, Mr. Doolittle is rushed to the hospital, where Dr. Input performs an emergency gastric resection. The hospital bills Medi care under the Part A coverage, and under the Part B coverage, the physician bills $450 for surgical services. The doctor agrees to accept assignment. The patient has not met any of his deductible for 2017 which is $183. Complete the following statements by putting in the correct amounts.

Original Bill

a.       Medicare allows $400. Medicare payment:

 

b.      Patient owes Dr. Input

 

 

c.       Dr. Input 's courtesy adjustment Mathematical computations:

Problem 2:

Mrs. James has Medicare Parts A and B coverage. She met her deductible

when she was ill in March of this year. On November 1, Dr. Caesar performs a bilateral salpingooophorectomy. The hospital bills Medicare under the Part A coverage, and under Part B coverage, the physician bills $300 for surgical services. The doctor agrees to accept a Medicare assignment.

Original Bill

a.  Medicare allows $275. Medicare payment:

 

 

b.  Patient owes Dr. Caesar: c. Dr. Caesar's courtesy adjustment Mathematical computations for surgeon:

 

 

 

 

The assistant surgeon charged Mrs. James $60 (the Medicare limiting charge) and does not accept assignment. After receiving her check from Medicare, Mrs. James sends the surgeon his $60. Medicare has allowed $55 for the fee.

 

d. How much of the money was from Mrs. James' private funds?

 

 

e.How much did Medicare pay? Mathematical computations:

 

Problem 3: You work for Dr. Coccidioides. He does not accept assignment. He is treating Mr. Robinson for allergies. Mr. Robinson has Medicare Part A. You send in a bill to Medicare for the $135 that Mr. Robinson owes you. What portion of the bill will Medicare pay?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Problem 4: In June, Mr. Fay has an illness that incur s $89 in medical bills. He asks you to bill Medicare, and the physician does not accept assignment. He has paid the deductible at another physician 's office.

a.  If Medicare allows the entire amount of your fees the Medicare check to the patient is $ (which comes to you).

 

 

b.  The patients t's part of the bill to you is _ Mathematical computations:

Problem 5:

Mr. Iba, a Medicare patient with a Medigap insurance policy, is seen for an office

visit, and the fee is $80. The Medicare-approved amount is $54.44. The patient has met his deductible for the year.

a.  The Medicare payment check is $

 

 

b.  After the claim is submitted to the Medigap insurance, the Medigap payment check is $ _

 

 

 

c.  To zero out the balance, the Medicare courtesy adjustment is _ _ _ _ _ _ _ _

Mathematical computations:

Problem 6:

Mrs. Smith, a Medicare patient, had surgery, and the participating physician’s

fee is $1250. This patient is working part-time, and her employer group health plan (primary insurance) allowed $1100, applied $500 to the deductible, and paid 80% of $600.

a.Amount paid by this plan: $ _

 

b.The spouse’s employer group health plan (secondary insurance) is billed for the

balance, which is$ _ This program also has a $500 deductible. This plan pays 100% of the fee billed, minus the deductible.

 

 

c. The spouse's employer group plan makes a payment of _

 

You send copies of the remittance advice from the two group health plans and submit a claim to Medicare (the third insurance)for $1250. The balance at this point is$ _

Mathematical computations:

 

 

 

 

 

 

 

 

 

 

Problem 7: Beverly James has Medicare Part B coverage. She has $242 in medical bills and has met $100 of the $183 (2017 deductible). Dr. Practon agrees to accept assignment.

Original Bill

a.  Medicare allows $200. Medicare payment:

 

b.  Beverly James owes Dr. Practon:

 

 

c.  Dr. Practon's courtesy adjustment Mathematical computations:

Problem 8: Oliver Mills has Medicare Part B coverage. He fell at home and suffered a sprain and Dr. Skeleton treated him. His medical bill totaled $370, and he has met $60 of the $183 (2017 deductible). Dr. Skeleton agrees to accept assignment.

Original Bill

a.  Medicare allows $280. Medicare payment:

 

b.  Oliver Mills owes Dr. Skeleton:

 

c.  Dr. Skeleton's courtesy adjustment:

Mathematical computations:

 

 

 

 

 

 

 

 

 

Problem 9: Maria Sanchez has Medicare Part B coverage. She has $565 in medical bills at Dr. Cardi's office and met $45 of the $183 (2017 deductible) at another physician's office. Dr. Cardi agrees to accept assignment.

Original Bill

a.  Medicare allows $480. Medicare payment:

 

 

b.  Maria Sanchez owes Dr. Cardi

 

 

 

 

 

c.  Dr. Cardi's courtesy adjustment Mathematical computations: