Name: ________________________________________
Date: _________________________________________
Procedure 14-1:
Calculating Patient Financial Responsibility
Objective: Calculate the patient’s financial responsibility using the charges, deductible, coinsur-
ance, and allowed amounts.
Equipment and Supplies: Pen; paper; insurance verification of benefits form; patient’s insurance
identification card; Remittance Advice form; calculator
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
Procedure_14-1 to 19-2.indd Page 1 26/04/17 9:55 AM f-0046-new /206/PH03233/9780134473062_BEAMAN/BEAMAN_PEARSON_COMPREHENSIVE_MEDICAL_ASSISTING_ ...
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 eective.
3. Explain to the patient that
the amount charged for any
particular procedure in the
medical oce 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.
Procedure_14-1 to 19-2.indd Page 2 26/04/17 9:55 AM f-0046-new /206/PH03233/9780134473062_BEAMAN/BEAMAN_PEARSON_COMPREHENSIVE_MEDICAL_ASSISTING_ ...
Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
8. Add the deductible to the
coinsurance amount to determine
the amount the patient needs to
pay out of pocket for the visit.
9. Explain the figures to the
patient, and collect the fees.
GRADING
Points Earned
Points Possible 69 69
Percent Grade (Points Earned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ________________________________________ Date: _______________________________
Procedure_14-1 to 19-2.indd Page 3 26/04/17 9:55 AM f-0046-new /206/PH03233/9780134473062_BEAMAN/BEAMAN_PEARSON_COMPREHENSIVE_MEDICAL_ASSISTING_ ...
click to sign
signature
click to edit