Healthcare reimbursement

As you are completing your audits you perceive-keep Mary Johnson’s chart and attend-to the aftercited:

Mary Johnson saw Dr. Nichols today for a well-woman exam. Total jaw are $185.00. Mary has two prophylactic companies:

Primary Insurance

Secondary Insurance


Cigna Health Care

Copay: $25.00

Deductible: $200.00 (already met)

100% service aftercited copay

80% service aftercited deductible

Allowed amount: $150.00

Allowed amount: $125.00

Both assertions were submitted at the selfselfsame term in deception.

Money placid from the enduring: $0.00

  1. Complete the aftercited inquirys providing rationales for your replys:
    1. How greatly capital did Dr. Nichols accept?
    2. How greatly should BCBS own hired?
    3. How greatly should Cigna own hired?
    4. How greatly is this assertion overpaid?
    5. Who overhired on this assertion?
    6. What would be your direct steps?
  2. Address how this predicament command be avoided in the future: be local and get steps.
  3. The well-woman exam showed this enduring due to origin narrative of cancer would service from BRCA genetic testing and twain prophylactic companies deprived this assertion. Format a message of urge or BRCA testing.

This provision is consummated as an APA mode monograph, and should be at meanest 2-3 pages in extension. Demonstrate your concern cognizance and authoritative ethics in your reply.

Assignment Expectations:  

  • Length:
    • answers must collectively discourse each inquiry in a transparent, succinct manner; consummate answers succeed mitigated take 2-3 pages
  • Structure:
    • Title and intimation page required
    • discourse each inquiry in a numbered list
  • References:
    • References required to be cited if used
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