Case 4 Part II

Part II - Paying for Physician Services - Overview

Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:

Categories               RVU  Geographic Cost Index  Product 

Work                         27.45  1.092                                 29.98

Practice Expense    43.05  1.743                                 75.04

Malpractice              10.32  0.543                                  5.60

Conversion Factor: 64.43

Part II – Assignment

Please answer in about 3 pages the following questions:

1. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?
2. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
3. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?