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For the following scenario, think about how you would explain this situation to the patient.
Mrs. Jones just turned 65 years old this year and became eligible for Medicare. She has Medicare A and selected Medicare B insurance to cover her outpatient services. She also has Medicare D for prescription plans. This is all of the coverage that she has because she did not obtain a Medigap plan.
Her deductible for the year has already been met for Medicare B. She received a statement from Dr. Smith’s office that shows that for her appointment last month, there was a $100 charge. Medicare paid $80, and she must pay $20. She does not understand why she must pay the $20. Is this a justifiable charge or an error? How would you explain this to her? HINT: Medicare B is 80/20 coinsurance. One Reference, 100-200 words
Claims must be accurately coded with documentation to support the diagnosis and code selection. Claims must also comply with insurance and government regulations. There are medical professionals who are certified to code and bill medical claims, but the medical administrative assistant may be required to enter basic codes related to the office visit (encounter) for the coding manager to review prior to submittal. Most medical practices have in-service training periodically to keep the staff aware of any compliance issues and to achieve better coding compliance. Explain the following coding errors and provide an example of each. (You will need to search the internet for more detail, so provide your reference source(s) in APA format.)
one reference, 100-200 words