How is Medicare reimbursement calculated for physicians?
There are a number of considerations when attempting to determine Medicare payment to physicians. The following identifies these and the methods of reimbursement calculation: • WHEN MEDICARE IS THE PRIMARY PAYER • Participating provider/assigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE (ALLOWED CHARGE) – DEDUCTIBLE) * .80 = PAYMENT DEDUCTIBLE & COINSURANCE (20%) MAY BE PAID BY EITHER A SECONDARY (MEDIGAP PLAN) OR THE BENEFICIARY. • Non-Participating provider/assigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE * .95) – (DEDUCTIBLE) * .80 = PAYMENT • Non-Participating provider/unassigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE * .95) – (DEDUCTIBLE) * .80 = PAYMENT BUT
There are a number of considerations when attempting to determine Medicare payment to physicians. The following identifies these and the methods of reimbursement calculation: • WHEN MEDICARE IS THE PRIMARY PAYER • Participating provider/assigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE (ALLOWED CHARGE) – DEDUCTIBLE) * .80 = PAYMENT DEDUCTIBLE & COINSURANCE (20%) MAY BE PAID BY EITHER A SECONDARY (MEDIGAP PLAN) OR THE BENEFICIARY. • Non-Participating provider/assigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE * .95) – (DEDUCTIBLE) * .80 = PAYMENT • Non-Participating provider/unassigned claims: (See the codes defined in the element called Line participating Indicator code in the Physician/Supplier record specifications. (FEE SCHEDULE * .95) – (DEDUCTIBLE) * .80 = PAYMENT BUT
