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 322 of the textbook) to help you with calculating reimbursement. Show your work.

  1. 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?
  2. 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.
  3. 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?
  4. 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?
  5. 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:
    1. limiting charge,
    2. Medicare’s portion,
    3. the patient’s portion, and
    4. the amount the provider can write off.

 

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