A. Participating physician’s standard fee: $300.00 Allowed amount: $200.00 Medic
ID: 393508 • Letter: A
Question
A. Participating physician’s standard fee: $300.00
Allowed amount: $200.00
Medicare pays 80%: $160
Patient or supplemental plan pays 20%: $40
Provider adjustment (write-off): $100
B. Nonpar physician’s standard fee (accepts assignment): $250.00
MFS: $200
Medicare nonpar fee:
Medicare pays 80%:
Patient or supplemental plan pays 20%:
Provider adjustment (write-off):
C. Nonpar physician’s standard fee (does not accept assignment): $250.00
MFS: $200
Medicare nonpar fee:
Limiting charge:
Patient billed:
Medicare pays patient:
Total provider can collect:
Patient out-of-pocket expense:
Provider adjustment (write-off):
Explanation / Answer
B. Nonpar physician’s standard fee (accepts assignment): $250.00
MFS: $200
Medicare nonpar fee: 95% MFS=$190
Medicare pays 80%: =$152
Patient or supplemental plan pays 20%: = $ 48
Provider adjustment (write-off): $50
C. Nonpar physician’s standard fee (does not accept assignment): $250.00
MFS: $200
Medicare nonpar fee: 109.25% of MFS=$218.50
Limiting charge: =115%
Patient billed: $218.50
Medicare pays patient: 0
Total provider can collect: $218.50
Patient out-of-pocket expense: $218.50
Provider adjustment (write-off): $31.50