Get Answer: Review Case Study Question Guide

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Original Question

Review the case study below. Describe in detail the steps needed to verify coverage with the patient’s insurance company. In your discussion make sure to include (and define the importance of) patient demographics, code linkage between the diagnosis and procedure codes, patient responsibility, and preauthorization. Determining Patient Responsibility. A patient presents to the office to see the provider for an annual skin check. Dr. Miller completes a skin exam and has two lesions she would like to biopsy. The patient signs the consent form for the biopsy procedures. The nurse prepares the patient for the two biopsies. The patient wonders how the insurance will cover the visit since the annual deductible has not yet been met. Dr. Miller asks the nurse to call the insurance for copay, deductible, and coinsurance information prior to performing the service. The nurse explains to the patient that there will be a $35 copay for the specialist visit, including the skin exam. The biopsies will be applied to the remaining deductible of $50 before applying the 80/20 coinsurance.

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