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 322 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 Healthcare 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:
- limiting charge,
- Medicare’s portion,
- the patient’s portion, and
- the amount the provider can write off.
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