ReimbursementQuestion 64 of 100
A patient has a $1,500 medical bill, an allowed amount of $1,000, has already met the deductible, and has a 20% coinsurance. How much is the patient's coinsurance responsibility?
a.$300, which is 20% of the billed charge
b.$500, the difference between billed and allowed
c.$200, which is 20% of the $1,000 allowed amount
d.$1,000, the full allowed amount
Explanation
Coinsurance is calculated on the allowed amount, not the provider's billed charge, so 20% of $1,000 equals $200. The $500 difference between the $1,500 charge and the $1,000 allowed amount is a contractual adjustment for a participating provider. The payer would pay the remaining $800 of the allowed amount.
Practice all 100 questions free — no signup required.
Related questions on this topic
- The 'allowed amount' on a claim is:
- A patient with a $500 remaining deductible receives a service with an allowed amount of $800 and 20% coinsurance after the deductible. What is the total patient responsibility?
- A copayment (copay) is best described as:
- A deductible is:
- The Resource-Based Relative Value Scale (RBRVS) determines physician payment based on:
- In the Medicare Physician Fee Schedule, the payment for a service is calculated by:
Last reviewed: · editorial process
PrepPass Editorial Team · Verified against NHA Certified Billing & Coding Specialist (CBCS) Exam · How we review