CMS Reimbursement Methodologies

Chapter 9 includes information about CMS’s reimbursement systems. As you read this chapter, you will see there are many terms and related issues associated with this reimbursement system. The healthcare programs that are administered by the federal government have a payment system that includes a predetermined reimbursement methodology.

Part of this system includes PAR and nonPAR physician charges.

 

1)explain how reimbursement differs between PAR and nonPar charges.

Also include your answer to number 1 and number 2 of the Chapter Review on page 371 of the Green & Rowell text

 

1. Calculate the following amounts for a PAR who bills Medicare:

Submitted charge (based on provider’s regular fee for office visit)is $75

Medicare physician fee schedule (PFS) is $60

Coinsurance amount (paid by patient or supplemental insurance) is $12

Medicare payment (80% of the allowed amount is? ______

Medicare write-off (not to be paid by Medicare or the beneficiary? ____

2. Calculate the following amounts for a nonPar who bills Medicare:

Submitted charge (based on provider’s regular fee) is $650

NonPAR Medicare physician fee schedule allow payment is $450

Limiting charge (115% of MPFS allowed amount) is?______

 

Medicare payment (80% of the MPFS allowed amount) is? ____

 

Beneficiary is billed the balance of the limiting charge $149.63

The Medicare write-off (not to be paid by Medicare of the beneficiary) is?____

2. Discuss how you determined your answers.

 

Please include citations/references and in-text citations in at least one of your posts.

Minimum word count for your major response post is 150 total words.

 

Include at least one reference and citation using APA 6th edition format.

 

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