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AMDO ST000001 Total Hip Replacement

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Revision as of 20:52, 17 March 2006 by Robert grant (talk | contribs)
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Mr. Adam Everyman is a 64-year-old male with severe pain in his right hip. He goes to his primary care provider, Dr. Patricia Primary, for an office visit.

Mr. Everyman has previously enrolled in Health Insurance Coverage The receptionist enters all the pertinent information (PA, FM PM) from Mr. Everyman’s health card into her office system, verifies eligibility, and generates a charge - FM for the office visit to be invoiced at the end of the day to Mr. Everyman’s insurance carrier. During the office visit with Dr. Primary, Mr. Everyman is diagnosed with inflammation of the hip and receives a prescription for Naprosyn 500 mg. The prescription is for 30 tables to be dispensed, with directions to read “to be taken 3 times daily with food”.

At the end of the day, the receptionist transmits the information of all patients seen that day for the insurance carrier, including Mr. Everyman’s office visit, to the insurance carrier’s third party administrator. The receptionist receives a response from the third party administrator that they have received the Invoice and will inform the receptionist of the results when the Invoice is adjudicated. Four days later the receptionist receives the results of the adjudicated invoice results from the insurance carrier that they will pay $30.00 for Mr. Everyman’s office visit.

The above includes the following transactions: (move to separate page)

  • 1. Delayed billing for an office visit (batching)
  • 2. Delayed adjudication results