# A non-participating physician provides services

A non-participating physician provides services to a Medicare patient who has total charges of \$100 (before Medicare’s limiting charge is applied). The physician does not accept assignment, charges the maximum allowable, and submits the claim to Medicare. Assume Medicare’s approved schedule for these services is \$80. A. What is the Medicare portion of the physician payment (that Medicare sends to the patient)? B. What is the patient’s portion of the payment to the physician (net of the reimbursement from Medicare in the information above?
Doctor charge        \$100
Medicare approved    80

x participating factor    0.95
Medicare allowed    76

x MAC factor        1.15
Max allowable charge    87.4
Medicare payment (80%)    69.92

Patient Payment        17.48
Total allowed        87.4

A. What is the Medicare portion of the physician payment (that Medicare sends to the patient)?
B. What is the patient’s portion of the payment to the physician (net of the reimbursement from Medicare in the information above?
3. Use the information and table below to solve problems 3A and 3B. The Medical College of Virginia, located in the urban city of Richmond, Virginia, has a wage index of 1.8579. A student from nearby Virginia Commonwealth University has just been treated for viral meningitis during a five-day length of stay (LOS), (DRG weight: 1.535). Rate Table Hospital Status Labor Non-labor Urban Areas 2,800 1,250 Rural Areas 2,000 1,000 A. Calculate the DRG operating payment for this treatment. B. Assuming that the wage index remains the same, what would the DRG operating payment be if the same treatment occurred in the rural Pulaski County Hospital in Pulaski, VA?
A. Calculate the DRG operating payment for this treatment.
B. Assuming that the wage index remains the same, what would the DRG operating payment be if the same treatment occurred in the rural Pulaski County Hospital in Pulaski, VA?

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