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For the following problems (as applicable), assume that the Medicare/patient split of payments is as covered in the book. Assume that the participating/non-participating and maximum allowable charge are as covered in the book. Ignore the patient’s annual deductible.

Also use the following information to solve the problems on this page of the quiz.

Dr. Andrea Johnson is trying to decide whether to be a Medicare-participating physician for the upcoming year. (Assume that her entire practice consists of Medicare patients or at least that her practice has slack capacity. Her Medicare patients do not displace non-Medicare patients.) Assume that her average charge is $120 (before Medicare’s limiting charge is applied), for which the average Medicare-approved amount is $100. If she decides to be a non-participating physician, she expects to accept assignment 80% of the time. For the unassigned patients assume that she would set her charges at 110 percent of the Medicare-approved fee for a nonparticipating physician. Assume that her Medicare patient volume is not reduced if she chooses not to participate nor if she does not accept assignment. (Ignore bad debt and any other factors not presented here.)

1. What will be Dr. Rose’s average reimbursement per visit if she chooses to be a Medicare-participating physician? (This is the total from both Medicare and the patients.)

2. What will be Dr. Rose’s average reimbursement per visit if she chooses
not to be a Medicare-participating physician? (This is the total from both Medicare and the patients.)

For the following problems (as applicable), assume that the Medicare/patient split of payments is as covered in the book. Assume that the participating/non-participating and maximum allowable charge are as covered in the book. Ignore the patient’s annual deductible.

Also use the following information to solve the problems on this page of the quiz.

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.

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

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

 
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