Week 1 Discussion 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. • What is the maximum amount the physician is allowed to charge the patient? The most the physician is allowed to charge the patient is $87.40. The following shows the calculation: [approved fee for participating physician x Medicare’s approved schedule] x max fee for non-participating physicians = amount physician is allowed to charge [95% x $80] x 115% = [.95 x 80] x 1.15= 87.40 • What is the Medicare portion of the physician payment (which Medicare sends to the patient)? The Medicare portion of the physician’s payment that Medicare sends to the patient is $69.92. The following shows the calculation: [percent Medicare pay for x amount physician is allowed to charge] = Medicare portion [80% x $87.40] = [.80 x 87.40] = 69.92
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- Fall '15
- Discussion , Payment, Physician