Insurance and Healthcare Reimbursement
For this assignment, you create a Power Point Presentation discussion ACA and health insurance. Address the following questions in the presentation
Discuss in your own words at least 2 advantages and 2 disadvantages to MCO’s (2-3 slides)
Discuss the specific characteristics of HMO’s (how are HMO’s different from other plans?) (2-3 slides)
Discuss the specific characteristics of PPO’s (2 to 3 slides)
In your own words, explain how Obamacare/Affordable Care Act has changed healthcare in America. (3-4 slides)
Show the case scenarios (below) (4-6 slides)
In each case scenario that follows, calculate the financial responsibility of the patient and/or carrier and the discounted amount that the physician must write off. Show calculations and identify amounts. Student should complete each case on a separate slide. Students can place the questions on the slide, then provide the answers with calculations.
Felix Grossman was seen today for an upper respiratory infection. Total charges for today’s services are $140. The allowed amount is $90. What is the discount amount and the amount the carrier pays to the provider?
Emma Mastrangelo had a CT scan of the brain today because of recurrent migraines. Total charges are $720.50. Her benefits pay 90 percent of this procedure. The allowed amount is $462.60. What is the patient responsibility, discount amount, and the amount the carrier pays provider?
Mabel Smith was seen in the office today for a checkup on her rheumatoid arthritis. Total charges are $85. The allowed amount is $52. She has a copay of $10. What is the discount amount, and the amount the carrier pays provider?
Rufus Durst had a cholecystectomy performed today. Total charges are $2995.70. His benefits pay 60 percent of this procedure. The allowed amount is $1745.32. What is the patient responsibility amount, discount amount, and the amount the carrier pays? What amount will the physician write off?
For this section, insure information is referenced and cited in your slides. The presentation should start with a title slide and end with a reference slides. If you include pictures, you pictures should also be referenced and cited.