(Solved): Use the Medicare Physician Schedule Look-up tool search results (Figure 9-1) to locate price and cha ...
Use the Medicare Physician Schedule Look-up tool search results (Figure 9-1) to locate price and charge data, and calculate the amounts paid by Medicare and patients. When calculating the provider and patient payments, use mathematical rounding rules.
2. A participating provider (PAR) charges $125 for a level 3 established patient evaluation and management service. If the non-facility price for MAC locality 0111209 is $90.08, what will the PAR receive as payment from Medicare?
3. A PAR charges $125 for a level 3 established patient evaluation and management service. If the non-facility price for MAC locality 0111255 is $77.72, what will the PAR receive as payment from the patient?
4. An established patient receives level 3 evaluation and management services from a nonparticipating provider (nonPAR). What is the non-facility limiting charge for MAC locality 0111205? (Go to Figure 9-1, locate the Non-Facility Limiting Charge column, and go to row 2 where MAC locality 0111205 data can be found.)
5. A nonPAR charges $125 for a level 3 established patient evaluation and management service. If the non-facility limiting charge for MAC locality 011209 is $98.41, what will the nonPAR receive as payment from patient? (Figure 9-1 contains a column of non-facility limiting charges, which means the limiting charge is not separately calculated. Remember! NonPARs are paid 80 percent of the limiting fee, less an additional 5 percent.)
