A. Participating physician’s standard fee: $300.00 Allowed amount: $200.00 Medic

ID: 393508 • Letter: A

Question

A. Participating physician’s standard fee: $300.00

Allowed amount: $200.00

Medicare pays 80%: $160

Patient or supplemental plan pays 20%: $40

Provider adjustment (write-off): $100

B. Nonpar physician’s 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 physician’s 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):

B. Nonpar physician’s standard fee (accepts assignment): $250.00

MFS: $200

Medicare nonpar fee: 95% MFS=$190

Medicare pays 80%: =$152

Patient or supplemental plan pays 20%: = $ 48

Provider adjustment (write-off): $50

C. Nonpar physician’s standard fee (does not accept assignment): $250.00

MFS: $200

Medicare nonpar fee: 109.25% of MFS=$218.50

Limiting charge: =115%

Patient billed: $218.50

Medicare pays patient: 0

Total provider can collect: $218.50

Patient out-of-pocket expense: $218.50

Provider adjustment (write-off): $31.50

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