How much will a nonparticipating physician receive from Medicare for a service with a standard fee of $120, if the Medicare non-PAR fee is $57?

How much will a nonparticipating physician receive from Medicare for a service with a standard fee of $120, if the Medicare non-PAR fee is $57?

• A. $120.00
• B. $60.00
• C. $57.00
• D. $45.60

Answer: (D)

To determine how much a nonparticipating physician will receive from Medicare for a service with a standard fee of $120, given that the Medicare non-participating (non-PAR) fee is $57, it is essential to understand how Medicare reimbursement works for non-PAR physicians. Nonparticipating physicians do not accept Medicare's allowed amounts as payment in full. Instead, they can choose to bill the patient an amount equal to the standard fee (here, $120), but they will receive only a percentage of the non-PAR fee from Medicare. Typically, Medicare pays 80% of the non-PAR fee after the annual deductible has been met, leaving the patient responsible for the balance. Calculating this, the non-PAR fee is $57, and the physician will receive 80% of this amount from Medicare. This calculation is as follows: 80% of $57 = 0.80 * $57 = $45.60. This means that the physician will receive $45.60 from Medicare for the service provided, which corresponds to the amount the correct choice reflects. Hence, the correct answer is $45.60.

To determine how much a nonparticipating physician will receive from Medicare for a service with a standard fee of $120, given that the Medicare non-participating (non-PAR) fee is $57, it is essential to understand how Medicare reimbursement works for non-PAR physicians.

Nonparticipating physicians do not accept Medicare's allowed amounts as payment in full. Instead, they can choose to bill the patient an amount equal to the standard fee (here, $120), but they will receive only a percentage of the non-PAR fee from Medicare. Typically, Medicare pays 80% of the non-PAR fee after the annual deductible has been met, leaving the patient responsible for the balance.

Calculating this, the non-PAR fee is $57, and the physician will receive 80% of this amount from Medicare. This calculation is as follows:

80% of $57 = 0.80 * $57 = $45.60.

This means that the physician will receive $45.60 from Medicare for the service provided, which corresponds to the amount the correct choice reflects. Hence, the correct answer is $45.60.