If a participating physician who accepts assignment charges $250.00 for a service with a PAR Medicare Fee Schedule amount of $200.00, what is the total amount the physician will receive?

If a participating physician who accepts assignment charges $250.00 for a service with a PAR Medicare Fee Schedule amount of $200.00, what is the total amount the physician will receive?

• A. $200.00
• B. $250.00
• C. $218.50
• D. $190.00

Answer: (A)

In the scenario described, the participating physician has charged $250 for a service, but the Medicare Fee Schedule amount established for that service is $200. When a physician participates in Medicare and accepts assignment, they agree to accept the Fee Schedule amount as full payment for the services rendered. This means that even though the physician billed $250, the insurance will only cover the predetermined amount of $200. The total amount the physician will receive is therefore the Fee Schedule amount of $200, reflecting their agreement to accept this payment as full reimbursement for the service provided. This arrangement ensures that beneficiaries are not billed more than the Fee Schedule amount for covered services, and it allows physicians who participate to receive timely payments while providing predictable costs for patients under Medicare.

In the scenario described, the participating physician has charged $250 for a service, but the Medicare Fee Schedule amount established for that service is $200. When a physician participates in Medicare and accepts assignment, they agree to accept the Fee Schedule amount as full payment for the services rendered.

This means that even though the physician billed $250, the insurance will only cover the predetermined amount of $200. The total amount the physician will receive is therefore the Fee Schedule amount of $200, reflecting their agreement to accept this payment as full reimbursement for the service provided.

This arrangement ensures that beneficiaries are not billed more than the Fee Schedule amount for covered services, and it allows physicians who participate to receive timely payments while providing predictable costs for patients under Medicare.