AH154_checklist_7_

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Plaza College *

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AH154

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Mechanical Engineering

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Dec 6, 2023

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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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