Understanding Health Insurance - Chapter 9 | 84 Questions and Answers(A+ Solution guide)

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare physician fee schedule (PFS)$ 60 Coinsurance amount (paid by patient or supplemental insurance)$ 12 Medicare payment (80 percent of the allowed amount)$ ????? Medicare write-off (not to be paid by Medicare or the beneficiary)$ ????? - Medicare payment (80 percent of the allowed amount) $48 Medicare write-off (not to be paid by Medicare or the beneficiary) $15 Calculate the following amounts for a nonPAR who bills Medicare: Submitted charge (based on provider's regular fee)$ 650 NonPAR Medicare physician fee schedule allowed amount$ 450 Limiting charge [MPFS - (MPFS × 5 percent)] × 115 percent$ ?????? Medicare payment (80 percent of the MPFS allowed amount, less 5 percent)$ ?????? Beneficiary is billed the balance of the limiting charge$ 149.63 Medicare write-off (not to be paid by Medicare or the beneficiary)$ ????? - Limiting charge [MPFS - (MPFS × 5 percent)] × 115 percent $491.63 Medicare payment (80 percent of the MPFS allowed amount, less 5 percent) $342 Medicare write-off (not to be paid by Medicare or the beneficiary) $158.37 Calculate the following amounts for a nurse practitioner who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare allowed amount (according to the Medicare physician fee schedule)$ 60Nurse practitioner allowed amount (100 percent of MPFS)$Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare physician fee schedule (PFS)$ 60 Coinsurance amount (paid by patient or supplemental insurance)$ 12 Medicare payment (80 percent of the allowed amount)$ ????? Medicare write-off (not to be paid by Medicare or the beneficiary)$ ????? - Medicare payment (80 percent of the allowed amount) $48 Medicare write-off (not to be paid by Medicare or the beneficiary) $15 Calculate the following amounts for a nonPAR who bills Medicare: Submitted charge (based on provider's regular fee)$ 650 NonPAR Medicare physician fee schedule allowed amount$ 450 Limiting charge [MPFS - (MPFS × 5 percent)] × 115 percent$ ?????? Medicare payment (80 percent of the MPFS allowed amount, less 5 percent)$ ?????? Beneficiary is billed the balance of the limiting charge$ 149.63 Medicare write-off (not to be paid by Medicare or the beneficiary)$ ????? - Limiting charge [MPFS - (MPFS × 5 percent)] × 115 percent $491.63 Medicare payment (80 percent of the MPFS allowed amount, less 5 percent) $342 Medicare write-off (not to be paid by Medicare or the beneficiary) $158.37 Calculate the following amounts for a nurse practitioner who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare allowed amount (according to the Medicare physician fee schedule)$ 60Nurse practitioner allowed amount (100 percent of MPFS)$ Medicare payment (80 percent of the allowed amount)$ - Nurse practitioner allowed amount (100 percent of MPFS) $60 Medicare payment (80 percent of the allowed amount) $48 Medicare payment (80 percent of the allowed amount)$ - Nurse practitioner allowed amount (100 percent of MPFS) $60 Medicare payment (80 percent of the allowed amount) $48