Question

Allen who is a non-par provide who doesn't accept assignment performs an appendectomy on a 67 year old Medicare patient. The physician's UCR for the surgery is $1500. Medicare's approved fee for this procedure is $1100. What is the charge that this non-par provider can charge to this Medicare patient?

A) $1100
B) $1200
C) $1500
D) $1600

Answer 1

The maximum charge a non-par provider can charge a Medicare patient is 115% of the Medicare approved fee. In this case, it's 115% of $1100, amounting to $1265. The closest allowable charge in the given options is $1200.

Step-by-step explanation:

The question asks about the charge that a non-participating (non-par) provider who does not accept assignment can charge a Medicare patient for a procedure when their usual and customary rate (UCR) is different from the Medicare approved amount. A non-par provider who does not accept assignment can choose to charge more than the Medicare approved amount, but by law, the limit is 115% of the Medicare approved amount. In this specific case, the Medicare approved fee is $1100, so the maximum that the non-par provider can legally charge the Medicare patient is 115% of $1100, which is $1265.

Since $1265 is the maximum legal limit and is not explicitly presented in the options, we can assume that the closest available option that does not exceed this amount would be the correct answer. Thus, the maximum charge provided in the options that the non-par provider could charge the Medicare patient is $1200 which is answer choice B.