ReimbursementCâu 63 / 100
The 'allowed amount' on a claim is:
a.The provider's full billed charge
b.The maximum amount a payer will pay for a covered service under the contract or fee schedule
c.The patient's annual deductible
d.The amount written off as bad debt
Giải thích
The allowed amount is the contracted or fee-schedule maximum the payer recognizes as payment for a covered service. It is often lower than the provider's billed charge, and the difference for a participating provider is a contractual write-off. Patient responsibility, such as coinsurance, is calculated from the allowed amount, not the billed charge.
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Câu hỏi liên quan cùng chủ đề
- 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 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:
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