1. Applying Medicare Physician and Other Health Professional Payment System Provisions (Level 3Applying)

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

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. And 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.

Physician or Health Professional	Total Reimbursement	Reimbursement Amount from Medicare	Reimbursement Amount from Beneficiary
Dr. Foraker
Dr. Barnes at Pleasant Physician Office
Dr. Barnes via mobile unit in Hocking County
Dr. Roberts
Ms. Murphy
Ms. Hamilton
Mr. Silverman