HITT 2335_Week 5_CDartez

Assignment Week 5 Applying Medicare Physician and Other Health Professional Payment System Provisions Pleasant Physicians is a small physician practice in Ohio. The practice members are as follows:  Dr. Foraker, primary care physician  Dr. Barnes, primary care physician  Dr. Roberts, primary care physician  Ms. Murphy, nurse practitioner  Ms. Hamilton, physician assistant  Mr. Silverman, registered dietitian Scenario:  Dr. Foraker is a Medicare nonparticipating physician who does not accept assignment for his Medicare patients. Dr. Foraker treats 5% of the Medicare patients that come to this practice.  Dr. Barnes is a Medicare participating physician. Dr. Barnes sees most Medicare patients that come to the practice (85 percent). Also, she sees patients in the office Monday through Thursday. On Fridays, she takes a mobile unit to Hocking County and treats patients there. Hocking County is an underserved area for primary care and is designated as a health professional shortage area (HPSA) by the US Health Resources and Services Administration (HRSA).  Dr. Roberts is a Medicare nonparticipating physician who accepts assignment for her Medicare patients. Dr. Roberts treats 10 percent of the Medicare patients.  Ms. Murphy and Mr. Silverman treat patients independent of physician supervision.  Ms. Hamilton practices incident to Dr. Barnes. Complete the following table by determining Medicare payments under RBRVS. The Medicare Physician Fee Schedule (MPFS) amount is $78.00. The first one is completed as an example. Upload to BB as a Word document or pdf. Physician or Health Professional Total Reimbursement Reimbursement Amount from Medicare Reimbursement Amount from Beneficiary Dr. Foraker $85.22 (Claim limited charge of 115% of 95% MPFS) (1.15 × (.95 × $78.00)) $0.00 (MAC does not reimburse physician) $85.22 MAC reimburses patient $59.28 (80% of non-PAR amount) Beneficiary coinsurance $14.82 (20% of non-PAR amount) Beneficiary $11.12 (the balance of the bill since the provider does not accept assignment) Dr. Barnes at Pleasant Physician Office $78.00 (PAR receives 100% MPFS) 78.00 x .80=$62.40 (MAC reimburses physician 80%) 78.00 x .20= $15.60 (Beneficiary reimburses physician 20%) Dr. Barnes via mobile unit in Hocking County $78.00 + 7.80 =$85.80 (MPFS +10% bonus for HPSA) $85.80 x .80=$68.64 (MAC reimburses physician 80%) $85.80 x .20=$17.16 (Beneficiary reimburses physician 20%)