Reference no: EM133920358

Health Insurance Calculations - Medicare Participating Provider

Please review the lecture information prior to completing this task. This scenario is for a provider who contracts with Medicare. More information is available to you on pages 322-330 of your text. Get expert-level assignment help in any subject.

Health Insurance Calculations - Medicare Participating Provider
Please review the lecture information prior to completing this task. This scenario is for a provider who contracts with Medicare. More information is available to you on pages 322-330 of your text.

Specific tips are:
Participating provider receives the full amount listed on the Medicare Physician's Fee Schedule (MPFS or PFS).
The copay may be paid by the patient or supplemental insurance.

Analyze a scenario to determine monetary responsibility for a visit.
Calculate the figures for each category under both scenarios.
Scenario 1A
Calculate the following amounts for a participating provider who bills Medicare and has no deductible left.

Submitted charge (based on provider's regular fee) $650
Medicare participating physician fee schedule (PFS) $450
Coinsurance amount (20% paid by) $
Medicare payment (80 percent of the PFS) $
Provider write-off $

Scenario 1B
Calculate the following amounts for a participating provider who bills Medicare and the remaining annual deductible for the patient.

Submitted charge (based on provider's regular fee) $650
Medicare participating physician fee schedule (PFS) $450
Patient pays $100 remaining on their deductible $
Remaining amount for Insurance and patient to pay $
(PFS - $100)
Coinsurance amount (20% of remaining amount) $
Total paid by patient (deductible & 20% of remaining) $
Medicare payment (80 percent of the remaining amount) $
Provider write-off