Medical billing workbook: six solved account exercises

1. Reconcile a simple ledger

Given: Fictional account WB-01 has a charge of $250. The teaching remittance assigns $70 to an authorized adjustment and records $144 as payer payment. The remaining amount is unresolved until the appropriate responsibility checks are completed.

Your tasks: Calculate the unresolved amount. Write an equation that accounts for the full charge. Explain why a mathematical remainder is not sufficient evidence to send a patient statement.

Worked answer: $250 − $70 − $144 = $36. The equation is $250 = $70 adjustment + $144 payment + $36 unresolved. The remainder explains the ledger, but does not prove who legally or contractually owes it. The learner must examine the relevant determination, benefits, applicable protections and organizational procedure before deciding the next action.

Work note: “WB-01: posted exercise payment $144 and documented adjustment $70; $36 remains unresolved. Responsibility evidence requires review. Assigned to the account reviewer; follow-up date to be set under the training workflow.”

Roman Urdu: Balance nikalna aur patient ki zimmedari sabit karna alag kaam hain.

2. Find the duplicate posting

Given: WB-02 has a $500 charge, a supported $200 adjustment and one $240 payment. A trainee accidentally enters the same $240 payment twice. No second deposit or separate payment reference exists.

Your tasks: Calculate the erroneous ledger balance and the correct balance. Describe what evidence should be checked before correcting the duplicate.

Worked answer: The erroneous balance is $500 − $200 − $240 − $240 = −$180. With only one supported payment, the balance is $60. Compare the remittance identifier, payment reference, deposit evidence and posting history. Follow the authorized correction procedure while preserving the audit trail. Do not invent an additional charge to offset the mistake.

Self-check: An unexplained credit balance is a reason to investigate, not automatic permission to issue a refund.

Roman Urdu: Ek hi payment do dafa post ho to asal reference aur history check karein.

3. Explain a batch mismatch

Given: Three fictional claim payments are $120, $85 and $195. The batch deposit is $385. A separate, documented provider-level offset of $15 is included in the teaching scenario. Assume there are no other events.

Your tasks: Reconcile the batch. Explain why dividing the $15 difference equally among the three patient accounts would be unsupported.

Worked answer: Claim payments total $400. Subtracting the separately documented $15 offset produces the $385 deposit. The equation is $120 + $85 + $195 − $15 = $385. The scenario does not allocate the offset to the three patient accounts. Preserve its separate reference and follow the approved posting procedure. An arbitrary $5 adjustment on each account would invent an allocation.

Work note: “Batch reconciles at $385 after the documented $15 provider-level offset. Claim payment total is $400. Offset retained separately with its source reference.”

Roman Urdu: Deposit ka farq har claim par andazay se distribute na karein.

4. Separate sent, accepted and paid

Given: WB-04 contains a transmission log dated Monday. A Tuesday response rejects the file because a required administrative field is missing. There is no payer acceptance or adjudication evidence. A colleague proposes resending the unchanged file and marking the account paid to clear the work queue.

Your tasks: Identify the latest supported status. Write a three-step next-action plan. Name two conclusions the records do not support.

Worked answer: The file was transmitted and a rejection was received. Payment is not established. First, identify the exact reported field and compare it with the authorized source record. Second, correct the actual issue through the applicable workflow. Third, retain proof of the new submission and track its response. The records support neither payer acceptance nor payment. Repeating an unchanged rejected file does not resolve the known issue.

Work note: “WB-04: rejected response reviewed; required field needs validation against source record. Correction assigned for review. Account remains unresolved pending subsequent acceptance and determination evidence.”

Roman Urdu: Sent ka matlab accepted ya paid nahi hota.

5. Calculate a meaningful response rate

Given: A fictional training cohort contains 80 claims with one initial outcome recorded per claim: 60 accepted and 20 rejected. Twelve rejected claims are later corrected and accepted. The exercise measures the first submission only; no claim has multiple initial outcomes.

Your tasks: Calculate the initial acceptance and rejection rates. Calculate how many claims eventually have acceptance evidence. Explain why those two acceptance measures should not share the same label.

Worked answer: Initial acceptance is 60 ÷ 80 × 100 = 75%. Initial rejection is 20 ÷ 80 × 100 = 25%. After the stated corrections, 72 claims have acceptance evidence. This is 90% of the original cohort, but it is not the initial acceptance rate. Report the measurement stage and observation period so the reader knows whether corrected submissions are included. Acceptance still does not mean payment.

Roman Urdu: Pehli submission ka rate aur correction ke baad ka result alag report karein.

6. Write a handoff another learner can use

Given: WB-06 has two lines. Line A: charge $180, supported adjustment $60, payer payment $96 and $24 modeled responsibility. Line B: charge $120, no payment and an unresolved response requiring investigation. There is no evidence establishing patient responsibility for Line B.

Your tasks: Reconcile the $300 account. Draft a handoff with the issue, evidence, next action, owner and follow-up date. Explain why a $144 patient statement is not supported.

Worked answer: $300 = $60 adjustment + $96 payer payment + $24 modeled responsibility + $120 unresolved. A $144 statement would combine the modeled $24 with an unresolved $120 whose liability has not been established. The correct handoff preserves the distinction between the two lines.

Example handoff: “WB-06: Line A reconciles using the stated teaching remittance. Line B remains unresolved at $120. Review its actual response and supporting documentation to choose the applicable inquiry, correction or appeal route. Assigned to the training reviewer; follow-up date must be set after checking the relevant instructions. No unsupported transfer to the patient.”

Roman Urdu: Har line ka status alag dekhein; unresolved amount ko patient balance na samjhein.

Suggested study method

Attempt each case before reading its worked answer. Keep your original calculation, then write one sentence explaining any correction. Score the calculation separately from the reasoning: a correct number with an unsupported next action is not a complete answer. All amounts and account identifiers above are fictional.