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:
Expert Solution Preview
Introduction:
As a medical professor, it is important to understand the various reimbursement methods of the Medicare program to properly educate and prepare future healthcare professionals. In this assignment, we will be examining five scenarios related to Medicare reimbursement and using Chapter 9 of the textbook to calculate the correct reimbursement amounts. It is important to pay close attention to the details in each scenario, including whether the provider accepts Medicare or not.
Answer to Question 1:
Mr. Allgood was charged $215 for the procedure at Meadowview Medical Center, but the Medicare Physician Fee Schedule (MPFS) for the procedure is $150. Since Meadowview accepts Medicare as a participating provider, Medicare would be responsible for the lower amount of $150. Therefore, Medicare would pay $150 for the procedure.
Answer to Question 2:
Mrs. Holloway was charged $1,000 for her surgery at Oceanside Surgery Center, which accepts Medicare assignment. However, the MPFS for this surgery is $917. Mrs. Holloway should not have been billed $200 from Oceanside Surgery Center since the center is required to accept the MPFS amount as payment in full for enrolled Medicare patients. Therefore, Mrs. Holloway was not billed the correct amount.
Answer to Question 3:
Mr. Tee underwent a procedure on his lower back as a Medicare patient with a non-participating provider. The MPFS for the procedure was $849. Medicare is responsible for paying 80% of the MPFS amount ($849 x .80 = $679.20). The patient is responsible for paying the remaining 20% ($169.80).
Answer to Question 4:
Ms. Poppins received treatment for her hip from New Scenery Medical Group, which accepts Medicare. She was charged $73 for the treatment, but the MPFS for the treatment is $70. Since Ms. Poppins is responsible for $14 of the charges, New Scenery Medical Group can write-off the difference between the charges and the MPFS amount as uncollectible ($73 – $70 – $14 = $-11). Therefore, New Scenery Medical Group can write-off $11 as uncollectible.
Answer to Question 5:
Uptownship Health Care provided medical services to Mr. Rogers for $750, but the MPFS for the service is $615. Since Uptownship Health Care does not accept Medicare assignment, Medicare is only responsible for paying 80% of the MPFS amount ($615 x .80 = $492). Mr. Rogers is responsible for the remaining 20% ($123).
