Week 1 Discussion Health Care Finance

docx

School

Keiser University *

*We aren’t endorsed by this school

Course

FIN3373

Subject

Medicine

Date

Oct 30, 2023

Type

docx

Pages

Uploaded by eaarela

1. A nonparticipating physician has a lower fee schedule. Medicare sets a maximum fee for a nonparticipating physician equal to 115% of the approved fee for nonparticipating physician, which is already only 95% of the approved fee schedule for a participating physician [ CITATION Cle18 \l 1033 ] The maximum amount a non-participating physician can charge a Medicare patient is 115% of Medicare's approved schedule amount. In this case, the approved schedule amount is $80, so the maximum the physician can charge the patient is 115% of $80, which is $80 * 1.15 = $92. Medicare will pay 95% of the approved schedule amount. In this case, the approved schedule amount is $80, so Medicare will pay $80 * 0.95 = $76 to the physician. Since the physician charged $100 and Medicare will reimburse $76, the patient's portion of the payment is the difference between the charge and the Medicare payment. Therefore, the patient's portion is $100 - $76 = $24. If the physician had accepted the assignment, they would have agreed to accept Medicare's approved schedule amount as payment in full. In this case, that amount is $80. By not accepting an assignment, the physician charged $100, and the patient had to pay the difference between $100 and the Medicare reimbursement of $76. Therefore, in this specific case, the physician would have been better off financially if they had accepted the assignment. The difference between the patient's portion in this case ($24) and what they would have received by accepting the assignment ($0 because the patient would not have had to pay anything beyond the approved schedule amount) is $24. 2. The proportion of Medicaid patients a hospital treats has a significant impact on its costs. A hospital must increase its prices when there are a lot of Medicaid patients in order to make up for the lost revenue. This is due to the fact that Medicaid reimbursement rates are far lower than those of private insurance. References Cleverley, W., & Cleverley, J. (2018). Essentials of Health Care Finance. Burlington: Jones & Bartlett Learning.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version