Unit VI Scholarly Activity
Instructions
Medicare Reimbursement
This assignment will test your knowledge of reimbursement methods of the Medicare program. Below, there are five scenarios that deal with the reimbursement of services provided to a patient enrolled in the Medicare program. Pay close attention to the details in each scenario such as whether the provider accepts Medicare or not. Use Chapter 9 (starting on page 308 of the textbook) to help you with calculating reimbursement. Show your work.
- Mr. Allgood was just discharged from Meadowview Medical Center after receiving a procedure on his left leg. Mr. Allgood has Medicare coverage, which Meadowview accepts as a participating provider. Meadowview charges $215 for the procedure and the Medicare Physician Fee Schedule (MPFS) for the procedure is $150. What amount would Medicare be responsible for paying?
- Mrs. Holloway has just received a bill from Oceanside Surgery Center regarding her recent outpatient surgery. Oceanside accepts Medicare assignment and charges $1,000 for her surgery. The MPFS for this surgery is $917. Mrs. Holloway was billed $200 from Oceanside Surgery Center. Considering that Mrs. Holloway is enrolled in the Medicare program, was she billed the correct amount? Explain why or why not.
- Mr. Tee underwent a medical procedure on his lower back and is a Medicare patient. Mr. Tee has a good rapport with a local medical provider and wants them to do the procedure on him. This local provider is a non-participating provider and does not accept assignment from Medicare. The MPFS for the lower back procedure was $849. What amount is Medicare responsible for paying? How much is the patient responsible for paying?
- Ms. Poppins has just received treatment for an ailing hip from New Scenery Medical Group which accepts Medicare. New Scenery Medical Group charges $73 for the treatment provided to Ms. Poppins, and the MPFS for the treatment is $70. If Ms. Poppins is responsible for $14, how much can New Scenery Medical Group write-off as uncollectible?
- Mr. Rogers was seen by Uptownship Health Care where he was provided medical services to address pain in his abdomen. This provider does not accept Medicare assignment and charges $750 for this type of service. The MPFS for the service is $615. Provide the amounts for the items listed below:
How to Solve Unit VI Scholarly Activity Instructions Medicare Reimbursement This assignment will test your knowledge of reimbursement methods of the Medicare program. Below, there are five scenarios that deal with Nursing Assignment Help
Introduction:
Medicare is a federal program that provides health insurance coverage to individuals who are 65 years old or older, as well as those with certain disabilities or chronic conditions. As medical college students, it is important to understand the various reimbursement methods of the Medicare program. In this assignment, we will be analyzing five different reimbursement scenarios related to Medicare.
Answer:
1. Medicare would be responsible for paying $150 for Mr. Allgood’s procedure, as this is the Medicare Physician Fee Schedule (MPFS) for the procedure. Meadowview Medical Center charges $215 for the procedure, which leaves a remaining balance of $65. Since Meadowview accepts Medicare as a participating provider, they would be required to accept the MPFS payment of $150 as full payment for the service. Therefore, Medicare would pay $150, and the patient would not be responsible for any additional payments.
2. Mrs. Holloway was billed the incorrect amount, as the maximum amount she should have been charged was $183.40. This is calculated by taking the Medicare-approved amount of $917 and subtracting the Medicare reimbursement rate of 80%, which equals $733.60. Oceanside Surgery Center is a participating provider and accepts Medicare assignment; therefore, they cannot charge more than the remaining 20%, which equals $183.40. Since Mrs. Holloway was billed $200, she was overcharged by $16.60.
3. Since the local provider is a non-participating provider and does not accept assignment from Medicare, they can charge Mr. Tee up to 15% more than the MPFS rate. This means that the provider can charge up to $975.90, which is 115% of the MPFS rate of $849. Medicare is responsible for paying 80% of the MPFS rate, which is $679.20. The patient is responsible for paying the remaining 20%, which is $170.70.
4. To calculate the amount that New Scenery Medical Group can write off as uncollectible, we first need to determine the total cost of the service. The total cost is the amount charged by the provider plus the amount that the patient is responsible for paying. In this case, the total cost is $73 + $14 = $87. The MPFS rate for the treatment is $70. This means that New Scenery Medical Group can write off the difference between the total cost and the MPFS rate, which is $17.
5. Since Uptownship Health Care does not accept Medicare assignment, they can charge Mr. Rogers up to 15% more than the MPFS rate. This means that they can charge up to $706.75, which is 115% of the MPFS rate of $615. Medicare is responsible for paying 80% of the MPFS rate, which is $492. The patient is responsible for paying the remaining 20%, which is $123.35.
