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medicare casestudy revised

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medicare casestudy revised

Category: Coursework

Subcategory: Finance

Level: University

Pages: 1

Words: 275

Case Study: Medicare
Institutional Affiliation
Case Study
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 physician is allowed a maximum charge towards a patient for an unaccepted assignment at 115% of 95% of the Medicare-approved schedule (Cleverly and Cleverly, 2017). In the case provided above, the physician is thus expected to charge a maximum of the following as indicated by the calculations shown:
= 1.15*0.95*$80
What is the Medicare portion of the physician payment (which Medicare sends to the patient)?
Medicare’s portion is 80% of the 95% of the approved schedule (Connor, 2014). Medicare’s portion of the payment accorded the physician in the case provided can only calculated as follows:
= 0.80*0.95*$80
What is the patient’s portion of the payment to the physician (net of the reimbursement from Medicare in the previous question)?
Cleverly & Cleverly (2017) provide that a patient’s portion should be 20% of the 95% in the approved schedule. In this regard, the patient’s portion of the payment to the physician can be calculated as follows:

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