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Mr. Blue has health insurance with Spectrum Health Group.  Mr. Blue had emergency surgery at Coachline Medical Center and incurred gross charges of $40,000.  Under Spectrum’s contract with Coachline, the total reimbursement to be paid to Coachline is $24,000; Mr. Blue’s co-pay is $2,000, and Spectrum will pay $22,000.  Mr. Blue has been a patient at Coachline before, and has never paid his co-pay.  What amount of patient service revenue should Coachline record?

Use the following information for questions 23 through 25.  On January 1, General Hospital entered into a capitated contract with ABC Health Plans to provide healthcare services to 200,000 of ABC’s covered lives.  Under the terms of the contract, General Hospital receives $120 PMPM.  The contract is a global risk contract, and does not contain any risk sharing provisions.  On January 1, General Hospital entered into a capitated contract with ABC Health Plans to provide healthcare services to 200,000 of ABC’s covered lives.  The contract is a global risk contract, and does not contain any risk sharing provisions.  In researching General’s historical lag between when claims occur and when they are paid, you obtain the following information:  Claims paid in the month they are incurred:  15%  Claims paid in the month after they are incurred:  50%  Claims paid two months after they are incurred:  25%  Claims paid three months after they are incurred:  10%  You determine that the medical claims expense recorded for the months of March, April and May were $30 million, $27 million and $21 million, respectively.  During the month of June, General paid $25 million of medical claims, of which $3 million were for services rendered in June.  You also learn that General received but has not yet paid invoices from healthcare providers for services rendered to lives covered under General’s global risk contract; the invoices total $5 million of which $2 million relate to services rendered in June.  What is the amount of incurred but not reported (IBNR) claims General should have on its books at June 30, (rounded to the nearest million)?

Use the following information for questions 23 through 25.  On January 1, General Hospital entered into a capitated contract with ABC Health Plans to provide healthcare services to 200,000 of ABC’s covered lives.  The contract is a global risk contract, and does not contain any risk sharing provisions.  In researching General’s historical lag between when claims occur and when they are paid, you obtain the following information:  Claims paid in the month they are incurred:  15%  Claims paid in the month after they are incurred:  50%  Claims paid two months after they are incurred:  25%  Claims paid three months after they are incurred:  10%  You determine that the medical claims expense recorded for the months of March, April and May were $30 million, $27 million and $21 million, respectively.  During the month of June, General paid $25 million of medical claims, of which $3 million were for services rendered in June.  You also learn that General received but has not yet paid invoices from healthcare providers for services rendered to lives covered under General’s global risk contract; the invoices total $5 million of which $2 million relate to services rendered in June.  What is the estimated medical claims expense General should record for the month of June, assuming the historical lag schedule information is the most reliable information available?

Use the following information for questions 26 through 28. Mrs. Jones has health insurance provided by her employer.  Her coverage is a high deductible health plan offered by Blue Cross Blue Shield (BCBS); the amount of her deductible is $5,000.  Assume she has no co-pay. Mrs. Jones had emergency surgery at Pima Community Hospital (PCH), and her charges totaled $59,000.  BCBS has negotiated discounted rates with PCH; for the surgery Mrs. Jones had, the negotiated reimbursement is $30,000.  PCH bills BCBS $25,000, and bills Mrs. Jones $5,000  Assume that Mrs. Jones does not have the financial resources to pay her bill. What amount of net patient service revenue should PCH record related to Mrs. Jones surgery?

When a defendant who has a standard automobile insurance policy is sued by a plaintiff, his insurance company:

A medical authorization is needed in order for you to obtain medical records on behalf of your client.

The term for the burden of proof in a civil case

The attractive nuisance doctrine

The body of judicial decisions stretching back for centuries.

Ron is walking by a lake and sees Rick, a stranger, apparently drowning in deep part of the lake. Rick, clawing at the surface, yells out, “help! I’m drowning!” Ron, watching from the shore, does nothing to save Rick. Does Ron have a duty to save Rick?