In a word document work out the financial problems using the

In a word document, work out the financial problems using the information from the scenarios provided below. To earn full credit, you must show all your work. See Chapter 3 for participating physicians, and non-participating physicians who accept or reject the Medicare fee schedule.

1) A non-participating physician provides services to a Medicare patient who has total charges of $100 (before Medicare’s limiting charge is applied). The physician does not accept assignment, charges the maximum allowable, and submits the claim to Medicare. Assume Medicare’s approved schedule for these services is $80.

a. What is the Medicare portion of the physician payment (which Medicare sends to the patient)?

b. What is the patient’s portion of the payment to the physician (net of the reimbursement from Medicare in the previous question)?

2) A participating physician’s charges for tonsillectomy is $5000. The Medicare approved fee schedule is $3000.

a. What cost does Medicare pay out?

c. What cost does the patient pay out?

3) A non-participating physician charges $200 for a procedure. The Medicare approved fee schedule is $150. The physician accepts the fee schedule.

a. What cost does Medicare pay out?

b. What cost does the patient pay out?

Solution

1)Physician is non-participating and He doesn’t accept the assignment

Therefore,Total charge=$100

Medicare’s approved schedule=$80

Maximum charge=1.15*0.95*80 =$87.40 (Here assuming 1.15 is xMAC factor and 0.95 is participating factor, It should have been given)

a.Medicare portion=80*0.95*0.8=$60.80

b.Patient’s portion=80*0.95*0.2=$15.20

2)Here, since physician is participating therefore, maximum allowablecharge = $3,000

a.Medicare pay out cost =0.8*3,000 = $2,400

b.Patient pay out cost=0.2*3,000 = $600

3) Here physician is non-participating and accept the fee schedule

Therefore,Approved maximum amount=0.95*150=$142.50

a.Medicare pay out cost =0.8*142.50=$114

b.Patient pay out cost=0.2*142.50=$28.50