Just need Part A not sure if this chart answers it I added it just in case.
C Chegg eReader C CASE STUDIES A. Medicare Pa a Amazon.com Checkout + + chegg.com/reader/9780323583862/190/ 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 ... CASE STUDIES Ciri A. Medicare Part B benefits: When Phyllis Trent, age 72, was in the hospital, she received services from several providers in addition to the hospital. Some providers were PAR; some were nonPAR. 1. The first provider to visit Phyllis was Dr. Frank McDonald, her internist (a PAR provider) and her regular physi- cian. Dr. McDonald examined Phyllis and referred her to a surgeon, Dr. Maxwell Leonard. (Note: Phyllis has not met her deductible for the year.) Dr. McDonald's charges to Medicare were processed as follows: Charged for professional services: $500 Medicare-approved charges: $400 Phyllis owes deductible of: Medicare paid % XS $ Phyllis owes coinsurance of % XS 2. Dr. Leonard, the surgeon, is a Medicare PAR provider. He bills Medicare as follows: Charges for professional services: $1800 Medicare-approved charges: $1200 Medicare paid % X $ Phyllis owes deductible of Phyllis owes coinsurance of % X $ 3. Phyllis received a statement from the anesthesiologist, who is nonPAR with Medicare and does not accept assignment. The anesthesiologist billed Medicare as follows: Charges for professional services: $920 Medicare-approved charges: $800 Medicare paid % X $ = $ Phyllis owes deductible of Phyllis owes coinsurance of % X $ $ Plus excess charges of % X $ = $ 174 S Chapter 9 Conquering Medicare's Challenges Copyright 2018, Elsevier Inc. All rights reserved. 174 of 433 > C Chegg eReader C CASE STUDIES A. Medicare Pa a Amazon.com Checkout + + 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 a ... Table 9.2 2016 Medicare Benefits Table-Part B Ciri Benefits Individual Pays Premium $104.90 per month plus 20% of Medicare approved amount Deductible $166.00 a year Physician and other medical services MD accepts assignment 20% coinsurance MD does not accept assignment 20% coinsurance plus up to 15% over Medicare- approved fee Outpatient hospital care 20% coinsurance Ambulatory surgical services 20% coinsurance X-rays 20% coinsurance Durable medical equipment 20% coinsurance Physical, occupational, and speech therapy 20% coinsurance Clinical diagnostic laboratory services No coinsurance Home healthcare No coinsurance Outpatient mental health services 50% coinsurance Preventive services 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 of 433 > C Chegg eReader C CASE STUDIES A. Medicare Pa a Amazon.com Checkout + + chegg.com/reader/9780323583862/190/ 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 ... CASE STUDIES Ciri A. Medicare Part B benefits: When Phyllis Trent, age 72, was in the hospital, she received services from several providers in addition to the hospital. Some providers were PAR; some were nonPAR. 1. The first provider to visit Phyllis was Dr. Frank McDonald, her internist (a PAR provider) and her regular physi- cian. Dr. McDonald examined Phyllis and referred her to a surgeon, Dr. Maxwell Leonard. (Note: Phyllis has not met her deductible for the year.) Dr. McDonald's charges to Medicare were processed as follows: Charged for professional services: $500 Medicare-approved charges: $400 Phyllis owes deductible of: Medicare paid % XS $ Phyllis owes coinsurance of % XS 2. Dr. Leonard, the surgeon, is a Medicare PAR provider. He bills Medicare as follows: Charges for professional services: $1800 Medicare-approved charges: $1200 Medicare paid % X $ Phyllis owes deductible of Phyllis owes coinsurance of % X $ 3. Phyllis received a statement from the anesthesiologist, who is nonPAR with Medicare and does not accept assignment. The anesthesiologist billed Medicare as follows: Charges for professional services: $920 Medicare-approved charges: $800 Medicare paid % X $ = $ Phyllis owes deductible of Phyllis owes coinsurance of % X $ $ Plus excess charges of % X $ = $ 174 S Chapter 9 Conquering Medicare's Challenges Copyright 2018, Elsevier Inc. All rights reserved. 174 of 433 > C Chegg eReader C CASE STUDIES A. Medicare Pa a Amazon.com Checkout + + 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 a ... Table 9.2 2016 Medicare Benefits Table-Part B Ciri Benefits Individual Pays Premium $104.90 per month plus 20% of Medicare approved amount Deductible $166.00 a year Physician and other medical services MD accepts assignment 20% coinsurance MD does not accept assignment 20% coinsurance plus up to 15% over Medicare- approved fee Outpatient hospital care 20% coinsurance Ambulatory surgical services 20% coinsurance X-rays 20% coinsurance Durable medical equipment 20% coinsurance Physical, occupational, and speech therapy 20% coinsurance Clinical diagnostic laboratory services No coinsurance Home healthcare No coinsurance Outpatient mental health services 50% coinsurance Preventive services 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 of 433 >
