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Ch 10 Math. OT 232. Patient One. Has Medigap Her doctor is PAR. Dr. A’s usual fees? 60 + 17 = 77 Medicare’s fees? 48.25 + 8 = 56.25 Medicare pays? 56.25 * .80 = 45 Medigap pays? 56.25 * .20 = 11.25 Patient pays? 0.00 Dr. A’s write off? 77 – 56.25 = 20.75. Patient Two.
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Ch 10 Math OT 232
Patient One • Has Medigap • Her doctor is PAR
Dr. A’s usual fees? • 60 + 17 = 77 • Medicare’s fees? • 48.25 + 8 = 56.25 • Medicare pays? • 56.25 * .80 = 45 • Medigap pays? • 56.25 * .20 = 11.25 • Patient pays? • 0.00 • Dr. A’s write off? • 77 – 56.25 = 20.75
Patient Two • Has Medigap • His doctor is nonPAR • His doctor accepts assignment
Dr. B’s usual fees? • 40 + 162.50 = 202.50 • Medicare’s fees? • 35.75 + 73.25 = 109 • Medicare nonPAR fee? • 109 * .95 = 103.55 • Medicare pays? • 103.55 * .80 = 82.84 • Medigap pays? • 103.55 * .20 = 20.71 • Patient pays? • 0.00 • Dr. B’s write off? • 202.50 – 103.55 = 98.95
Patient Three • Does not have Medigap • Her doctor is nonPAR • Her doctor does not accept assignment
Dr. C’s usual fees? • 48 • Medicare’s fees? • 36 • Medicare nonPAR fee? • 36 * .95 = 34.20 • Limiting Charge? • 34.20 * 115% = 39.33 • Patient billed? • 39.33 • Medicare pays patient? • 34.20 * .80 = 27.36 • Patient pays? • 39.33 – 27.36 = 11.97 • Dr. C’s write off? • 48 – 39.33 = 8.67
