Based on this Medicare non-PAR situation, where the physician does not accept assignment, what is the patient’s out-of-pocket responsibility for this service?
Standard fee: $145.00
Charge limit (cap): $135.70
Medicare Approved: $118.00
(Reduced 5%)
Medicare pays (80%): $ 94.40
Coinsurance (20%): $ 23.60
a. $42.30 RATIONALE: $42.30 is the patient’s responsibility. The charge limit is $137.70. Medicare paid $94.40. The coinsurance and the difference between the Medicare-approved and charge limit ($42.30) are due from the patient.
b. $ 9.30
c. $27.00
d. $23.60
a. $42.30 RATIONALE: $42.30 is the patient’s responsibility. The charge limit is $137.70. Medicare paid $94.40. The coinsurance and the difference between the Medicare-approved and charge limit ($42.30) are due from the patient.
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