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-For the PDF: Explain or interpret the 4 cases of improvement on page: 280 (In the summary) from given information in the table.

-For the Numeric Problems: answer the questions.

-As they going to be presented, well explanation is required separatly.

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Numeric Problems

I.

Medicareâ€™s Payment to Physicians

Note: For the following problems (as applicable), assume that the Medicare/patient split of

payments is the same as covered in the book. Assume that the participating/non-participating

and maximum allowable charge are as covered in the book. Ignore the patientâ€™s annual

deductible.

Use the following information to solve problems 1, 2, 3 and 4.

Dr. Melissa Rose is trying to decide whether to be a Medicare-participating physician for the

upcoming year. (Assume that her entire practice consists of Medicare patients or at least that her

practice has slack capacity. Her Medicare patients do not displace non-Medicare patients.) Assume

that her average charge is $120 (before Medicareâ€™s limiting charge is applied), for which the average

Medicare-approved amount is $100. If she decides to be a non-participating physician, she expects to

accept assignment 80% of the time. For the unassigned patients assume that she would set her charges

at 110 percent of the Medicare-approved fee for a nonparticipating physician. Assume that her

Medicare patient volume is not reduced if she chooses not to participate nor if she does not accept

assignment. (Ignore bad debt and any other factors not presented here.)

1. What will be Dr. Roseâ€™s average reimbursement per visit if she chooses to be a Medicareparticipating physician? (This is the total from both Medicare and the patients.) $100

2. What will be Dr. Roseâ€™s average reimbursement per visit if she chooses not to be a

Medicare-participating physician? (This is the total from both Medicare and the patients.)

$97.85

3. Based strictly on the information presented here (ignore bad debt, patient mix differences,

and other considerations not presented here), should she choose to be participating or nonparticipating if she wishes to maximize her total reimbursement for services?

4. Will the conclusion of question 3 change if Dr. Rose decides to accept assignment 20% of

the time only? And why?

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