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AH154
Physician Fee Schedule Assignment
Revised Spring, 2022
PLAZA COLLEGE
Checklist Assignment 7: Physician Fee Schedule
Name: Chelsea Albrechtsen
Date: 11/7/2023
Instructions
: Please complete the assignment by reading the scenario and completing the fee information that follows
based on your knowledge of physician fee schedules and insurance regulations. You are required to explain your
responses for each one using complete, well structured sentences, typed in Times New Roman, size 12 font. Please
delete lines when typing your responses. You need to submit this sheet with the completed assignment.
Task
:
You are an RMA working in the primary care practice for Dr. David Wang. You have been working with the
insurance specialist for the practice and she has now asked you to determine patient responsibility for some patients
who were seen this week and may need to be billed for their deductible or coinsurance responsibility.
Objective
:
Discuss types of physician fee schedules including, RBRVS and capitation (BL2)
Standards:
Students must complete the assignment satisfactorily by achieving a minimum score of 74%. The time
approximate for completion of this assignment is 1.5 hours.
Assessment
Points
State Dr. Wang’s participation or non-participation in each plan
________/20
Determine payment responsibility for the insurer and the patient for each plan
________/20
Explain any payment
issues involving each insurer
________/20
Discuss reasons for patient responsibility where applicable
________/20
Use correct grammar, spelling, punctuation, and formatting
________/10
Timely submission of completed assignment
________/10
Total Points:
________/100
Repeat:
__________
2
nd
Attempt: ________ (
/84%)
3
rd
Attempt: _________ (
/74%)
Instructor: _______________________________
Date: ________________
1
AH154
Physician Fee Schedule Assignment
Revised Spring, 2022
Dr. David Wang is a PAR provider, participating, in Medicare and in Mountville Health Plan. Each plan has allowed
charges for services and does not permit balanced billing of plan members. He is not a PAR provider in the Ringdale
Medical Plan. Based on the following table of charges, calculate the charges that the payer and the patient will pay in
each of the situations.
Physician Fee Schedule
Service
CPT
Usual
Charge
Montville Health
Plan Allowed
Charge
Medicare
Allowed
Charge
OV/Outpt. New, Min.
OV/Outpt. New, Low
OV/Outpt. New Mod.
OV/Outpt. New Mod.
OV/Outpt. New High
OV/Outpt. Est. Min.
OV/Outpt. Est. Low
OV/Outpt. Est. Mod.
OV/Outpt. Est. Mod.
OV/Outpt. Est. High
Rhythm ECG with
Report
Breathing Capacity
Test
DTAP Immunization
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
93040
94010
90700
$54
$73
$100
$147
$190
$29
$44
$60
$87
$134
$30
$83
$102
$48
$65
$89
$129
$168
$26
$39
$54
$78
$119
$36
$69
$87
$43
$58
$80
$116
$151
$22
$35
$48
$70
$107
$30
$58
$74
1.
Insurance Plan: Mountville Health Plan
Patient has paid $125 toward an annual deductible of $500; 80-20 coinsurance
Services:
CPT 99215, 93040, 94010
Total Charges for Services Rendered: $ 224
Amount Due from Patient: $ 224
Payment from Insurance Payer: 0
a)
Is Dr. Wang a PAR provider in this plan: Yes.
b)
Will Mountville Health Plan reimburse Dr. Wang for any services provided to the
patient? Why/Why not?
Mountville Health Plan will not reimburse Dr. Wang for any services because the
patient has not met their annual deductible, therefore patient is responsible.
c)
Is the patient responsible for any charges? Why/Why not?
Yes, $224, the annual deductible has not yet been met.
2
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