Assignment 11.1: Final Project
Assignment
Directions
Dorothy Foster is a patient. She will visit one doctor on 2/11/1X and one doctor on 2/19/1X. You will be provided with the following Reference Materials in an Excel spreadsheet:
• New Patient Form
• Insurance Card
• Benefit Summary
• Encounter Form/Superbill
• Explanation of Benefits
Download the Final Project Excel spreadsheet. These spreadsheet contains forms which provide background information necessary to complete a ledger card and a CMS-1500 claim form for EACH visit. There are MULTIPLE TABS across the bottom of the spreadsheet so be sure to review each one. You will submit FOUR (4) Excel documents via the dropbox: 2 – Ledgers and 2 – CMS-1500 forms.
Ledger
The ledger is in Excel format. It will have the following columns:
DATE
DESCRIPTION OF SERVICE
CHARGE
PAYMENT
ADJUSTMENTS
REMAINING BALANCE
The ledger represents credits and debits to a patient’s account. Use the reference materials to document the charges the patient accrued during their encounter and any adjustments or payments made by the patient and insurance company.
CMS-1500 Form
The CMS-1500 form has 33 blocks of information. You must determine the correct information to put in each block, if any. Some blocks will remain blank. The blocks are represented in an Excel worksheet. Next to the block number, type in the required information for the claim.
Example:
2
FOSTER DOROTHY J
The “2” represents the block number. The space to the right is where you will type in the information exactly as it should appear on the claim.
Submit the (4) Excel documents to the dropbox “Assignment 11.1: Final Project.” This assignment is worth 100 points and will be graded according to the scoring guide below.
SCORING GUIDE (100 POINTS )
Rating Scale
25-23
Work meets or exceeds criterion at a high level of competence.
22-19
Work reflects an understanding of criterion with minor
misunderstandings/misconceptions.
18-15
Criterion partially met, but one or more important concepts/skills are
missing or flawed.
14-10
Work reflects an attempt to meet criterion, but significant
misunderstandings/misconceptions are apparent.
9-0
Criterion not met or work is absent.
Criteria
1.
The Ledger GYN Card/Statement of Account has been correctly filled out.
Answers are correct. There are no errors in formatting, grammar, spelling, or
plagiarism.
2.
The Ledger UC Card/Statement of Account has been correctly filled out.
Answers are correct. There are no errors in formatting, grammar, spelling, or
plagiarism.
3.
The CMS1500 GYN has been correctly filled out. Answers are correct.
There are no errors in formatting, grammar, spelling, or plagiarism.
4.
The CMS1500 UC has been correctly filled out. Answers are
correct. There are no errors in formatting grammar, spelling, or plagiarism.
