Health Insurance Calculations – Medicare Non-Physician Provider

Please review the lecture information prior to completing this task.  This scenario is for a non-physician provider, such as NP or PA, who contracts with Medicare.  More information is available to you in Chapter 9 of your text. 

Analyze a scenario to determine monetary responsibility for a visit.

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Fill in the blanks in the following payment situations:

 Scenario 1

Calculate the following amounts for a nurse practitioner who bills Medicare as incident to a supervising physician (billed under the physician’s NPI).

Submitted charge                                                                   $75

Medicare allowed amount (MPFS)                                         $60

Nurse practitioner allowed amount (100% of MPFS) $    

Medicare payment (80 percent of the allowed amount)        $    

Coinsurance amount (20% allowed amount)                         $    

Provider write-off                                                                    $    

 Scenario 2

Calculate the following amounts for a nurse practitioner who bills Medicare under their own NPI.

Submitted charge                                                                   $75

Medicare allowed amount (MPFS)                                         $60 

Nurse practitioner allowed amount                                         $    

(80% of office charge or 85% of MPFS whichever is lower)

Medicare payment (80% of the allowed amount)                  $       

Coinsurance amount                                                              $      

Provider write-off                                                                    $      

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