WK8 ASSIGNMENT1 HP-214

Health Insurance Calculations – Medicare Non-Physician Provider

Please review the lecture information prior to completing this task. This scenario is for a non-physician provider, such as an N.P. or P.A., who contracts with Medicare.

WK8 INFO HP-214

Health Insurance Calculations – Medicare Non-Physician Provider

Please review the lecture information prior to completing this task. This scenario is for a non-physician provider, such as an N.P. or P.A., who contracts with Medicare. More information is available to you in Chapter 9 of your text.

Analyze a scenario to determine monetary responsibility for a visit.

Fill in the blanks in the following payment situations:

Scenario 1

Calculate the following amounts for an NP who bills Medicare as an incident to a supervising physician (billed under the physician’s NPI).

Submitted charge $75

Medicare allowed amount (MPFS) $60

Nurse practitioner allowed amount (100% of MPFS) $

Medicare payment (80 percent of the allowed amount) $

Coinsurance amount (20% allowed amount) $

Provider write-off $

Scenario 2

Calculate the following amounts for an NP who bills Medicare under their own NPI.

Submitted charge $75

Medicare allowed amount (MPFS) $60

Nurse practitioner allowed amount $

(80% of office charge or 85% of MPFS whichever is lower)

Medicare payment (80% of the allowed amount) $

Coinsurance amount $

Provider write-off $