Fill out the information below and determine the amount owed by the patient after deductible has been met in the following situations. Provide the calculations used to determine your answers:

A. Participating physicians standard fee: $300.00

Allowed amount $200.00

Medicare pays 80%

Patient or supplemental plan pays 20%:

Provider adjustment (write-off):

B. Nonpar physicians standard fee (accepts assignment): $250.00

MFS: $200

Medicare nonpar fee:

Medicare pays 80%:

Patient or supplemental plan pays 20%:

Provider adjustment (write-off):

C. Nonpar physicians standard fee (does not accept assignment): $250.00

MFS: $200

Medicare nonpar fee:

Limiting charge :

Patient billed:

Medicare pays patient:

Total provider can collect:

Patient out-of-pocket expense:

Provider adjustment (write-off):