Name: ________________________________________
Date: _________________________________________
POINT VALUE
✦ = 3–6 points
✶ = 7–9 points
GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. ✦ After the patient’s insurance
coverage has been verified, locate
the information on the verification
form regarding the deductible and
coinsurance amount.
2. ✦ Inform the patient of the
deductible amount that needs
to be paid after the beginning
of the calendar or fiscal year,
before insurance payments
become eective.
3. ✦ Explain to the patient that
the amount charged for any
particular procedure in the
medical oce will likely be
reduced to a lower amount,
called the allowed amount,
when processed by the
insurance carrier.
4. ✦ After the insurance payment is
received, use the remittance
advice (RA) form to identify the
amount the insurance carrier
allowed on the claim.
5. ✶ Calculate the total allowed amount
by adding together the allowed
amount for each service.
6. ✶ Subtract the deductible from the
total of the allowed charges.
7. ✶ Multiply the remaining allowed
amount by the coinsurance
percentage to determine the
patient’s coinsurance amount.
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