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.$4250.00
c.$500.00
d.$450.00

Answer 1

Medicare will pay 80% of the allowable charge or the actual charge, whichever is less. Since the actual charge of $450.00 is less than the Medicare allowable charge of $500.00, and the deductible has been met, Medicare will pay 80% of $450.00, resulting in a payment of $360.00. However, this figure does not match any of the provided options, indicating a potential error in the question.

Step-by-step explanation:

In the scenario where a doctor performs a service costing $450 for a patient and the Medicare allowable charge for the service is $500, and the patient has met her deductible for the current year, Medicare typically pays 80% of the allowable charge. Here's the calculation:

Medicare allowable charge: $500.00

Medicare payment (80% of $500.00): $400.00

However, Medicare's payment cannot exceed the actual charge of the service provided. Since the doctor charged $450 for the service, which is less than the allowable charge, Medicare will pay 80% of the actual charge:

Medicare payment (80% of $450.00): $360.00

Note that none of the provided options (a) $380.00 (b) $4250.00 (c) $500.00 (d) $450.00 match the correct calculation based on the standard Medicare payment policy. Therefore, it is likely there was an error in the question choices provided or additional information regarding the Medicare coverage policy for this specific procedure is required.