Wiki Medicare Billing Question

[777280]

I've been working on CE's and came across this 'self test' question:

A Medicare patient is seen by as non-participating physician who accepts assignment. The office fee is $100 and the Medicare allowable is $80. Assuming the beneficiary has not met their annual deductible, the office would bill the patient for ________________.
a.) $16.00
b.) $20.00
c.) $76.00
d.) $80.00

Why is the correct answer c?

Thanks!
~Stacy

 

[myrleeme]

Medicare Non-Par provider fee schedule

Non-participating (non-Par) providers have a fee schedule set at 95% of Medicare approved amounts for PAR providers. Non-Par providers are allowed to charge above the Medicare approved amount with a limiting charge, which is set at 115% of the Medicare approved amounts for non-PAR providers.

The answer is $76.00 because:

1. the non-PAR provider accepts assignments, or Medicare's allowed amount for a service or procedure.
2. non-PAR providers are reimbursed at 95% of Medicare's approved amount - $80 X 95% = $76.00