C and D

C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + A chegg.com/reader/9780323583862/188/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords ... Table 9.2 2016 Medicare Benefits TablePart B Ciri Benefits Premium Individual Pays $104.90 per month plus 20% of Medicare approved amount $166.00 a year Deductible Physician and other medical services MD accepts assignment MD does not accept assignment 20% coinsurance 20% coinsurance plus up to 15% over Medicare- approved fee 20% coinsurance 20% coinsurance 20% coinsurance Outpatient hospital care Ambulatory surgical services X-rays Durable medical equipment Physical, occupational, and speech therapy Clinical diagnostic laboratory services Home healthcare Outpatient mental health services Preventive services 20% coinsurance 20% coinsurance No coinsurance No coinsurance 50% coinsurance Flu shots, pneumococcal vaccines, colorectal and prostate Part B deductible and 20% coinsurance are waived for cancer screenings, Pap smears, mammograms certain preventive services Bone mass measurement, diabetes monitoring, glaucoma 20% coinsurance screening * Referred to as the Medicare Limiting Charge Law, the limit on the percentage higher than the Medicare-approved amount that a physician can charge is less than 15% in some states. "There is an annual coverage limit on Medicare outpatient therapy services, which are subject to change every year. These limits can be found in the Medicare & You handbook published yearly. Note: For more detailed information on preventive and other benefits, see http://www.Medicare.gov. 172 C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + chegg.com/reader/9780323583862/189/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL | Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords a ... Ciri C. Louise Mayfair visits Broadmoor Medical Clinic on January 2, 20XX, and sees two different participating (PAR) providers. Dr. Aldrich charges $85; Dr. Bennett charges $78. Medicare approves $55 for Dr. Aldrich and $45 for Dr. Bennett. 1. If these were Mrs. Mayfair's first medical expenses of the year, and she has no other insurance, calculate how much Mrs. Mayfair owes each provider. Note: Use the information in Table 9.2 for this exercise. Dr. Aldrich: $ Dr. Bennett: $ 2. If Mrs. Mayfair's visits were to PAR providers, and Medicare pays 80% of the approved" charges, why must she pay these fees? 3. If Drs. Aldrich and Bennett had been nonPARs, how much more could they have charged Mrs. Mayfair? 4. On May 23, 20XX, Mrs. Mayfair visits Dr. Carbolla (a PAR provider) at Broadmoor Medical Clinic. Dr. Carbolla's charge for services was $130, and the Medicare-approved amount was $100. Calculate the amount Mrs. Mayfair owes for this encounter. (Assume she has now met her deductible.) $ $ Amount charged by Dr. Carbolla Medicare-approved amount Medicare will pay Mrs. Mayfair owes $ $ 5. Is Mrs. Mayfair responsible for the difference between the amount Dr. Carbolla charged ($130) and the Medicare- approved amount ($100)? Why or why not? 6. Do you as the health insurance professional need to address this $30 difference on Mrs. Mayfair's account? If so, how do you handle it? 7. Mrs. Mayfair was referred to Dr. Dykstrom on April 14, 20XX, a nonPAR provider (does not accept assignment). Dr. Dykstrom's charge was $115, of which Medicare approves $100. How much does Mrs. Mayfair owe in this scenario? $115 Dr. Dykstrom's charge (limiting) Medicare-approved amount $100 173 of 433 > C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + chegg.com/reader/9780323583862/189/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords a ... Mrs. Mayfair owes Ciri 5. Is Mrs. Mayfair responsible for the difference between the amount Dr. Carbolla charged ($130) and the Medicare- approved amount ($100)? Why or why not? 6. Do you as the health insurance professional need to address this $30 difference on Mrs. Mayfair's account? If So, how do you handle it? 7. Mrs. Mayfair was referred to Dr. Dykstrom on April 14, 20XX, a nonPAR provider (does not accept assignment). Dr. Dykstrom's charge was $115, of which Medicare approves $100. How much does Mrs. Mayfair owe in this scenario? Dr. Dykstrom's charge (limiting) $115 Medicare-approved amount $100 Medicare pays $ Mrs. Mayfair's coinsurance amount $ Allowed excess charge $ Total owed by Mrs. Mayfair $ D. Alicia Freemont, a 66-year-old patient with Medicare Part B, comes to see Dr. Beverly Carson, a dermatologist at Broadmoor Medical Clinic, and asks for dermabrasion treatments to reduce an unsightly scar on her face. You advise Ms. Freemont that this procedure may not be covered by Medicare; however, she insists that she wants it anyway. 1. What do you do? 2. Ms. Freemont remarks, "Well, if Medicare won't pay for it, my Medigap supplement policy will." Is she correct? Why or why not? E. What is the deadline for submitting a Medicare claims for services rendered October 14, 2016? 173 C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + A chegg.com/reader/9780323583862/188/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords ... Table 9.2 2016 Medicare Benefits TablePart B Ciri Benefits Premium Individual Pays $104.90 per month plus 20% of Medicare approved amount $166.00 a year Deductible Physician and other medical services MD accepts assignment MD does not accept assignment 20% coinsurance 20% coinsurance plus up to 15% over Medicare- approved fee 20% coinsurance 20% coinsurance 20% coinsurance Outpatient hospital care Ambulatory surgical services X-rays Durable medical equipment Physical, occupational, and speech therapy Clinical diagnostic laboratory services Home healthcare Outpatient mental health services Preventive services 20% coinsurance 20% coinsurance No coinsurance No coinsurance 50% coinsurance Flu shots, pneumococcal vaccines, colorectal and prostate Part B deductible and 20% coinsurance are waived for cancer screenings, Pap smears, mammograms certain preventive services Bone mass measurement, diabetes monitoring, glaucoma 20% coinsurance screening * Referred to as the Medicare Limiting Charge Law, the limit on the percentage higher than the Medicare-approved amount that a physician can charge is less than 15% in some states. "There is an annual coverage limit on Medicare outpatient therapy services, which are subject to change every year. These limits can be found in the Medicare & You handbook published yearly. Note: For more detailed information on preventive and other benefits, see http://www.Medicare.gov. 172 C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + chegg.com/reader/9780323583862/189/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL | Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords a ... Ciri C. Louise Mayfair visits Broadmoor Medical Clinic on January 2, 20XX, and sees two different participating (PAR) providers. Dr. Aldrich charges $85; Dr. Bennett charges $78. Medicare approves $55 for Dr. Aldrich and $45 for Dr. Bennett. 1. If these were Mrs. Mayfair's first medical expenses of the year, and she has no other insurance, calculate how much Mrs. Mayfair owes each provider. Note: Use the information in Table 9.2 for this exercise. Dr. Aldrich: $ Dr. Bennett: $ 2. If Mrs. Mayfair's visits were to PAR providers, and Medicare pays 80% of the approved" charges, why must she pay these fees? 3. If Drs. Aldrich and Bennett had been nonPARs, how much more could they have charged Mrs. Mayfair? 4. On May 23, 20XX, Mrs. Mayfair visits Dr. Carbolla (a PAR provider) at Broadmoor Medical Clinic. Dr. Carbolla's charge for services was $130, and the Medicare-approved amount was $100. Calculate the amount Mrs. Mayfair owes for this encounter. (Assume she has now met her deductible.) $ $ Amount charged by Dr. Carbolla Medicare-approved amount Medicare will pay Mrs. Mayfair owes $ $ 5. Is Mrs. Mayfair responsible for the difference between the amount Dr. Carbolla charged ($130) and the Medicare- approved amount ($100)? Why or why not? 6. Do you as the health insurance professional need to address this $30 difference on Mrs. Mayfair's account? If so, how do you handle it? 7. Mrs. Mayfair was referred to Dr. Dykstrom on April 14, 20XX, a nonPAR provider (does not accept assignment). Dr. Dykstrom's charge was $115, of which Medicare approves $100. How much does Mrs. Mayfair owe in this scenario? $115 Dr. Dykstrom's charge (limiting) Medicare-approved amount $100 173 of 433 > C Chegg eReader C AC. Louise Mayfair Visits Broa x a Amazon.com Checkout + + chegg.com/reader/9780323583862/189/ Hi Apps Student Home M... Bb BLACKBOARD Cengage 0 MHCC EMAIL Gmail b. Scholarship YouTube Netflix h hulu in LinkedIn Subscription - Sn... Book Online > Van... 18 Search keywords a ... Mrs. Mayfair owes Ciri 5. Is Mrs. Mayfair responsible for the difference between the amount Dr. Carbolla charged ($130) and the Medicare- approved amount ($100)? Why or why not? 6. Do you as the health insurance professional need to address this $30 difference on Mrs. Mayfair's account? If So, how do you handle it? 7. Mrs. Mayfair was referred to Dr. Dykstrom on April 14, 20XX, a nonPAR provider (does not accept assignment). Dr. Dykstrom's charge was $115, of which Medicare approves $100. How much does Mrs. Mayfair owe in this scenario? Dr. Dykstrom's charge (limiting) $115 Medicare-approved amount $100 Medicare pays $ Mrs. Mayfair's coinsurance amount $ Allowed excess charge $ Total owed by Mrs. Mayfair $ D. Alicia Freemont, a 66-year-old patient with Medicare Part B, comes to see Dr. Beverly Carson, a dermatologist at Broadmoor Medical Clinic, and asks for dermabrasion treatments to reduce an unsightly scar on her face. You advise Ms. Freemont that this procedure may not be covered by Medicare; however, she insists that she wants it anyway. 1. What do you do? 2. Ms. Freemont remarks, "Well, if Medicare won't pay for it, my Medigap supplement policy will." Is she correct? Why or why not? E. What is the deadline for submitting a Medicare claims for services rendered October 14, 2016? 173