Name: _____________________________

Reimbursement HW

To be completed within the next 4 hours max

Deadline: 4 Hours

Show all work and all calculations in detail and precision

I do not only want answers, I want all the steps, processes, calculations and info used to arrive at the answer as we

Exercise 1

Jane Doe is an 83-year-old patient who only has Medicare Part A insurance. After reviewing the following information, answer the questions regarding her listed hospitalizations.

DATE ADMITTED

DATE DISCHARGED

PATIENT’S FINANCIAL

RESPONSIBILITY

01/01

01/13

$912.00

03/20

03/30

$912.00

07/04

11/02

$21,888 ($912 + 6,840 + 14, 136)

12/01

12/05

$2,280

a. How many benefit periods were used during this calendar year?

___________

b. Were any lifetime reserve days used during this period of time? If so, how many?

___________

c. If lifetime reserve days were used, how many does the patient have left to be used at a later date?

___________

d. How many times was the patient required to pay a hospital deductible during this time period?

___________

e. Following this last hospital admission, Jane was transferred to a skilled nursing facility (SNF) and remained there for continued treatment for 22 days.

i. How much was Jane required to pay for her SNF care for days 1–20?

___________

ii. How much was she required to pay for the remainder of her SNF stay if the copay is $114?

___________

f. After Jane’s discharge from the skilled facility, she received home health care as prescribed by her physician for 14 days. During this time period, she met all Medicare’s medical necessity criteria for her care. How much did the patient have to pay for her home health care?

___________

Exercise 4

Use the tables below to answer the following questions. The first portion of part b “St. Louis” has been completed for you.

The national conversion factor for 2011 is $33.9764.

a. How much can a physician in St. Louis bill Medicare for an office visit (99203) for a new patient with a detailed history and physical and low-complexity medical decision making (assuming the patient has met any deductible for the year)?

Office visit (99203)

___________

Fee Schedules by Provider Type

Fill in the blanks with the correct dollar amounts as indicated

PAR Provider

Physician’s fee

$180.00

MFS

$105.00

Medicare pays 80% of MFS or

_____________

Patient pays 20% of MFS or

_____________

Physician write-off

_____________

Non PAR accepts assignment

Physician’s fee

$180.00

MFS

$105.00

Medicare NonPAR fee (95% of MFS)

_____________

Medicare pays 80% of nonPAR fee

_____________

Patient pays 20% of nonPAR fee

_____________

Physician write-off

_____________

Get help from top-rated tutors in any subject.

Efficiently complete your homework and academic assignments by getting help from the experts at homeworkarchive.com