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

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 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 $