Understanding Health Insurance, 10e
Corrections
Textbook
Chapter 6
Page 155
6. Contusion, abdomen abdominal organ
Chapter 9
Page 292
Nonparticipating Physicians
When the nonparticipating provider (nonPAR) does not accept assignment from Medicare, which means
the amount Medicare reimburses for services provided is subject to a 5 percent reduction of the Medicare
physician fee schedule
NOTE: NonPARs can accept assignment on a case-by-case basis, as discussed in Chapter 14.
Chapter 11
Page 389
The image in Figure 11-5 is incorrect in UHI 10e. The followoing image should have been inserted.
Chapter 12
Page 409
11 Enter the secondary or supplemental policyholder’s primary policy or group number. Do not enter
hyphens or spaces in the policy or group number.
11a Enter the secondary or supplemental policyholder’s primary birth date as MM DD YYYY (with spaces).
Enter an X in the appropriate box to indicate the policyholder’s gender. If the policyholder’s gender is
unknown, leave blank.
11b Enter the name of the secondary or supplemental policyholder’s primary employer (if employed) or
school (if unemployed and considered a full- or part-time student). Otherwise, leave blank.
11c
Enter the name of the secondary or supplemental policyholder’s primary commercial health
insurance plan.
Chapter 13
Page 438
Chapter 14
Page 488
11 Enter the secondary or supplemental policyholder’s primary policy or group number. Do not enter
hyphens or spaces in the policy or group number.
11a Enter the secondary or supplemental policyholder’s primary birth date as MM DD YYYY (with spaces).
Enter an X in the appropriate box to indicate the policyholder’s gender. If the policyholder’s gender is
unknown, leave blank.
11b Enter the name of the secondary or supplemental policyholder’s primary employer (if employed) or
school (if unemployed and considered a full- or part-time student). Otherwise, leave blank.
11c
Enter the name of the secondary or supplemental policyholder’s primary commercial health
insurance plan.
Workbook
Chapter 2
Page 29
3. The patient undergoes arthroscopic surgery at an ambulatory surgical center. The surgeon’s fee
is $890. The patient’s coinsurance is 20% of the $700 fee schedule. The payer reimburses the
surgeon $540 $560.
a. Enter the amount the patient pays the provider: ____________
b. Enter the amount the payer reimburses the provider: ____________
c. Enter the amount the provider “writes off” the account: ____________
4. The patient was referred to an orthopedic specialist for evaluation of chronic ankle pain. The
physician’s fee is $150. The patient’s copayment is $20. The payer reimburses the physician
40% of the $100 fee schedule for this service.
a. Enter the amount the patient pays the provider: ____________
b. Enter the amount the payer reimburses the provider: ____________
c. Enter the amount the provider “writes off” the account: ____________
5. The patient received preventive medicine services. The physician’s fee is $125. The patient’s
coinsurance is 20% of the $75 fee schedule. The payer reimburses the physician 60% 80% of the
$75 fee schedule.
a. Enter the amount the patient pays the provider: ____________
b. Enter the amount the payer reimburses the provider: ____________
c. Enter the amount the provider “writes off” the account: ____________
Chapter 4
Page 39
Changed Header from COPAY to COINS
Patient Jenny Baker REIMB: 45.00
Jenny Baker NET: 45.00
Patient John Cofee REIMB: 60.00
John Cofee NET: 60.00
Patient Jeanne Davis REIMB: 30.00
Jeanne Davis NET: 30.00
Patient James Eicher ALLOWED: 125.00
Patient Ed Feinstein ALLOWED: 650.00
Ed Feinstein COINS: 50.00
Ed Feinstein PT RESP: 50.00
TOTALS:
ALLOWED Amount: 955.00
Coinsurance Amount: 95.00
Provider paid amount: 860.00
Check Amount: 860.00
LEGEND:
Coinsurance changed to COINS
40
Changed Header from COPAY to COINS
Patient Morton Aldridge REIMB: 80.00
Morton Aldridge NET: 80.00
Patient Angel Brennan REIMB: 50.00
Angel Brennan NET: 50.00
Patient John Humphrey REIMB: 20.00
Jeanne Davis NET: 20.00
Patient Grayson Kihlberg CLAIM TOTAL: 135.00
Patient Zane Craig REIMB(code 99213): 50.00
Zane Craig CLAIM TOTAL: 135.00
Zane Craig NET: 95.00
TOTALS:
Total Amount: 520.00
Provider paid amount: 343.00
Check Amount: 343.00
LEGEND:
Coinsurance changed to COINS
41
Changed Header from Code (s) to PROC
Changed Header from COPAY/INS to COINS
Patient Andrew Gagner CLAIM TOTAL: 470.00
Andrew Gagner NET: 363.00
Christopher Hess CLAIM TOTAL: 80.00
Gabriella Stave CLAIM TOTAL: 90.00
Michael Thomas CLAIM TOTAL: 110.00
TOTALS:
Total Amount: 962.00
Provider paid amount: 691.00
Check Amount: 691.00
LEGEND:
Coinsurance changed to COINS
42
No edits.
43
Changed Header from Code (s) to PROC
Changed Header from COPAY/INS to COINS
Susan Brisbane CLAIM TOTAL: 105.00
Paulette Melfi CLAIM TOTAL: 40.00
Lynn Swanson CLAIM TOTAL: 220.00
Stacey Wilson CLAIM TOTAL: 140.00
Peggy Zigler CLAIM TOTAL: 75.00
TOTALS:
Total Amount: 580.00
Provider paid amount: 427.00
Check Amount: 427.00
LEGEND:
Coinsurance changed to COINS
44
Changed Header from Code (s) to PROC
Changed Header from COPAY/INS to COINS
Jason Brook CLAIM TOTAL: 112.00
Teresa Captain CLAIM TOTAL: 80.00
TOTALS:
Total Amount: 192.00
Provider paid amount: 132.00
Check Amount: 132.00
LEGEND:
Coinsurance changed to COINS
45
Changed Header from Code (s) to PROC
Changed Header from COPAY/INS to COINS
Suzette Brister CLAIM TOTAL: 135.00
Kathleen Smith CLAIM TOTAL: 90.00
Amos White CLAIM TOTAL: 75.00
TOTALS:
Total Amount: 300.00
Provider paid amount: 240.00
Check Amount: 240.00
LEGEND:
Coinsurance changed to COINS