Intermediate Exercises
1.
Medicare Cost Sharing (Level 3—Applying)
Scenario A
This is the third inpatient admission for Indie this year. Indie satisfied his deductible during the first admission. The length of stay for the first admission was 28 days. The second admission was for 25 days. The third admission was 19 days.
What is the cost sharing amount Indie owes for the third inpatient admission? Indie owes $4,224 for the third inpatient admission. The total length of stay for Indie is 72 days leaving 12 days under the benefit period at $352 per day.
Scenario B
Chloe’s primary care physician sent her to Memorial Hospital laboratory to get some bloodwork.
She has already met her outpatient deductible for the year.
What is the cost sharing amount for Chloe for the laboratory services?
Chloe owes nothing as the outpatient deductible was already met.
Scenario C
Raj is receiving home health services three times per week. The HHA approved two pieces of durable medical equipment (DME), a lift chair and a walker. The total allowable charge for the two DME items is $650. The total allowable charges for home health services for the most recent
60-day episode of care is $1,435. Raj has already met his inpatient and outpatient deductible for the year. What is the cost sharing amount for the home health services and the DME?
There is no cost for home health services. The durable medical equipment is included in Medicare Part B, however the beneficiary responsibility is 20% for DME. That would mean since the two DME items are $650, 20% of that would be $130 dollars.
Scenario D
Savannah saw her primary care physician in January for a sinus infection. The total allowed charges for the visit was $125. This was the first healthcare encounter for Savannah this year. What is the cost sharing amount for the physician visit?
Savannah owes the full $125 dollars because this is her first visit. This cost will go toward the $198 annual deductible.
