Question

In a hospital setting, a doctor, who participates in Medicare, performs a $450.00 service for a patient. The patient has met her deductible for the current year. The Medicare allowable charge for the service is $500.00. Medicare will pay:

Select one:
a. $380.00
b. $450.00
c. $4250.00
d. $500.00

Answer 1

Medicare will pay $400.00 (80% of the allowable charge) and the doctor will accept $400.00 as payment in full from Medicare.

Step-by-step explanation:

The Medicare allowable charge for the service is $500.00. Since the patient has already met her deductible for the current year, Medicare will pay 80% of the allowable charge. Therefore, Medicare will pay $400.00 (80% of $500.00). However, since the doctor participates in Medicare, they have agreed to accept the Medicare-approved amount as full payment for the service. So, the doctor will accept $400.00 as payment in full from Medicare.