MDC Benefits Explanation Technical and Lay Terms Questions

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Review figure 11.5, Explanation of benefits, in the textbook. Answer the following three questions.

a. Why are the charge and allowable charge different amounts? Explain your answer in technical terms and then explain your answer in layman’s terms.

b. Differentiate between the contractual adjustment and the charge. Explain your answer in technical terms and then again in layman’s terms.

c. If the procedure on line 4 was denied by the payer for incorrect coding, how would the benefit payment change? What are the revised benefit payment and coinsurance amounts?

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200 words

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