Please review the lecture information prior to completing this task. This scenario is for a non-physician provider, such as NP or PA, 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 a nurse practitioner who bills Medicare as 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 a nurse practitioner 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 $
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