Reference no: EM131354143

You work for a billing service. You have been assigned the duty of calculating what the patient owes and what the insurance company owes, so that you can determine what revenue to expect for these services. You have the charge and the usual, customary, and reasonable (UCR) amount. The reimbursement will be calculated on the 80/20 distribution. The deductibles for each of these patients have been met. Under this insurance plan, $20.00 copays are due for physician office visits but not for other services. Use the data in Table 2-30 to calculate the coinsurance; amount insurance will pay; and how much the patient owes, including any copays. Table 2-30 Calculating Commercial Insurance Reimbursement Calculating Commercial Insurance Reimbursement Service Charge UCR Copay Coinsurance Insurance Pays Physician Visit $120.00 $120.00 $20.00 Physical Therapy $150.00 $97.00 X-Ray $76.00 $43.00 MRI $1245.00 $1047.00 Physician Visit $65.00 $70.00 $20.00 Physician Visit $75.00 $70.00 $20.00