Dr. Melissa Rose is trying to decide whether to be a Medicare-participating physician for the upcoming year.

Here are the assumptions shell use for the calculations if she is Medicare-participating physician:

• Assume that her average charge is $120 (before Medicares limiting charge is applied), and the average Medicare-approved amount is $100. (notice these two amts are different)
• Medicare covers 80% of the payment and the patients co-payment is 20% of the payment.

Here are the assumptions shell use for the calculations if she is non-participating physician:

• Assume that shell accept assignment 80% of the time.
• For the unassigned patients, assume that she would set her charges at 110 percent of the Medicare-approved fee for a nonparticipating physician.
• Assume that her Medicare patient volume will not change if she chooses not to participate nor if he does not accept assignment.

Questions to respond to:

1. What will be Roses average reimbursement per visit if she chooses not to be a Medicare-participating physician? (Average reimbursement includes payment from both Medicare (80%)

2. Based strictly on the information presented here should she choose to be participating or non-participating if she wishes to maximize her total reimbursement for services?