Calculate the Medicare payment for a participating provider who bills Medicare with a submitted charge of $75 and a Medicare physician fee schedule of $60. What is the Medicare payment?

Calculate the Medicare payment for a participating provider who bills Medicare with a submitted charge of $75 and a Medicare physician fee schedule of $60. What is the Medicare payment?

• A. $48
• B. $60
• C. $75
• D. $12

Answer: (A)

To determine the Medicare payment for a participating provider, we need to understand how the payment system works in relation to submitted charges and the Medicare physician fee schedule. In this case, the provider submitted a charge of $75, but the Medicare fee schedule for the service rendered is set at $60. Medicare payment to a participating provider is based on the lower of the submitted charge or the fee schedule amount. Since the fee schedule is $60, this is the amount that will be used to calculate the Medicare payment. Typically, Medicare pays 80% of the allowed amount for services when the provider is a participating member. Therefore, if the fee schedule amount is $60, Medicare would cover 80% of this amount. Calculating this gives: 80% of $60 = 0.80 * 60 = $48. Thus, the Medicare payment for the service billed by the participating provider would indeed be $48, corroborating the correct choice in this scenario.

To determine the Medicare payment for a participating provider, we need to understand how the payment system works in relation to submitted charges and the Medicare physician fee schedule. In this case, the provider submitted a charge of $75, but the Medicare fee schedule for the service rendered is set at $60.

Medicare payment to a participating provider is based on the lower of the submitted charge or the fee schedule amount. Since the fee schedule is $60, this is the amount that will be used to calculate the Medicare payment.

Typically, Medicare pays 80% of the allowed amount for services when the provider is a participating member. Therefore, if the fee schedule amount is $60, Medicare would cover 80% of this amount.

Calculating this gives:

80% of $60 = 0.80 * 60 = $48.

Thus, the Medicare payment for the service billed by the participating provider would indeed be $48, corroborating the correct choice in this scenario.