Reference no: EM131269687

Exercise 1 - Jane Doe is an 83-year-old patient who only has Medicare Part A insurance. After reviewing the following information, answer the questions regarding her listed hospitalizations.

DATE ADMITTED	DATE DISCHARGED	PATIENT'S FINANCIAL RESPONSIBILITY
01/01	01/13	$912.00
03/20	03/30	$912.00
07/04	11/02	$21,888 ($912 + 6,840 + 14, 136)
12/01	12/05	$2,280

a. How many benefit periods were used during this calendar year?

b. Were any lifetime reserve days used during this period of time? If so, how many?                     

c. If lifetime reserve days were used, how many does the patient have left to be used at a later date?

d. How many times was the patient required to pay a hospital deductible during this time period?

e. Following this last hospital admission, Jane was transferred to a skilled nursing facility (SNF) and remained there for continued treatment for 22 days.

i. How much was Jane required to pay for her SNF care for days 1-20?

ii. How much was she required to pay for the remainder of her SNF stay if the copay is $114?

f. After Jane's discharge from the skilled facility, she received home health care as prescribed by her physician for 14 days. During this time period, she met all Medicare's medical necessity criteria for her care. How much did the patient have to pay for her home health care?

Exercise 2 - Use the tables below to answer the following questions. The first portion of part b "St. Louis" has been completed for you.

Table 6.7 Sample 2011 RVUs for selected HCPCS codes
HCPCS Code	Description	Work RVU	Facility Practice Expense RVU	Malpractice Expense RVU
99203	Office visit	1.42	.72	.14
99204	Office visit	2.43	1.21	.23
11010	Debridement skin at fracture site	4.19	3.49	.76
45380	Colonoscopy with biopsy	4.43	2.73	.67
52601	TURP, complete	15.26	8.09	1.49

 

Table - Sample GPCIs for selected U.S. cities
City	Work GPCI	Practice Expense GPCI	Malpractice Expense GPCI
St. Louis	.99163	.939923	1.05944
Dallas	1.0113	.99943	.82543311
Spokane	.98989	.932469	1.670886

The national conversion factor for 2011 is $33.9764.

a. How much can a physician in St. Louis bill Medicare for an office visit (99203) for a new patient with a detailed history and physical and low-complexity medical decision making (assuming the patient has met any deductible for the year)?

Fee Schedules by Provider Type

Fill in the blanks with the correct dollar amounts as indicated

PAR Provider
Physician's fee	$180.00
MFS	$105.00
Medicare pays 80% of MFS or	_____________
Patient pays 20% of MFS or	_____________
Physician write-off	_____________
Non PAR accepts assignment
Physician's fee	$180.00
MFS	$105.00
Medicare NonPAR fee (95% of MFS)	_____________
Medicare pays 80% of nonPAR fee	_____________
Patient pays 20% of nonPAR fee	_____________
Physician write-off	_____________