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patient bill total is $1,200, if their indemnity plan's coinsurance rate is 75-25. Patient's coinsurance is $300Insurance will pay $ TERM 2 Physician's capitation rate is a monthly fee of $2,000 based on a fee of $50 for 40 patients who are in the plan. Since only 10 patients visited the practice last month, how much is the capitation payment? DEFINITION 2 $2,000 the capitation rate remains the same regardless of the number of patients who visit each month. TERM 3 The Medicare allowed charge is $80. What amount does the participating provider receive from Medicare, and what amount from the patient, assuming the patient deductible has been met? DEFINITION 3 Medicare will pay $64Patient pays $16Medicare rate is 80- TERM 4 The Medicare allowed charge for a procedure is $150, and a PARprovider's usual charge is $200. what amount must the provider write- off? DEFINITION 4 $ TERM 5 Most payers set their fees... DEFINITION 5 slightly above those paid by the highest reimbursement plan
True or False the conversion factor is multiplied by a relative value unit to arrive at a charge True TERM 7 What is the purpose of GPCI? DEFINITION 7 The purpose of GPCI accounts for regional differences in cost TERM 8 What is the RBRVS method? DEFINITION 8 RBRVS is a method used to set fees for Medicare TERM 9 Under the RBRVS. the uniform value relative unit is based on what three things? DEFINITION 9 the provider's work, practice cost, and malpractice insurance costs TERM 10 What is the formula to calculate RBRVS fees? DEFINITION 10 Multiply the RVU by its GPCI. add the three adjusted totals, and multiply the sum by its (annual) conversion factor.
What percentage of the fee on the Medicare NonPAR Fee Schedule is the limiting charge? 115% TERM 17 True or False Medicare Part B's monthly premium is based on social security benefit rates DEFINITION 17 True TERM 18 Under the Medicare program, if the approved amount for a procedure is $100, the participating physician will be paid $100 (by Medicare and the patient), and the nonparticipant who accepts assignment will be paid: DEFINITION 18 $ TERM 19 What is the coinsurance percentage for Medicare Part B? DEFINITION 19 20%
