Health Insurance Calculations – Medicare Non-Participating Provider

Health Insurance Calculations – Medicare Non-Participating Provider This scenario is for a non-participating provider who contracts with Medicare. Prior to determining the limiting charge, you must first decrease the PFS amount by 5%. More information is available in Chapter 9 of your text, pages 322-330 ( text book: MindTap for Greene, M.A. (2020). Understanding Health Insurance: A Guide to Billing and Reimbursement (15th ed.) . Specific tips are: Non-Participating Medicare physician receives a 5% reduction of the MPFS Limiting charge = the highest amount provider can collect from patient and insurance Limiting charge = [MPFS – (5% x MPFS)] x 115% Analyze a scenario to determine monetary responsibility for a visit. Scenario Calculate the following amounts for a non-participating provider who bills Medicare. calculation table Item Amount Submitted charge (based on provider’s regular fee) $650 Medicare-participating physician fee schedule allowed amount $450 Medicare Non-participating physician allowed amount (MPFS allowed amount, less 5 percent) Medicare payment (80% of MPFS allowed, less 5 percent) $ Limiting charge to patient $ [MPFS – (MPFS x 5 percent)] x 115 percent Patient payment $ (balance of the limiting charge minus Medicare payment) Provider write-off $ use above chart to complete this assignment. there is no attachment to include. I also proved the book link to use SCIENCE HEALTH SCIENCE NURSING HP 214

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