if the standard fee for a Medicare coverd service is $150 and the Medicare non-PAR fee schedule for the service is $80, what is the limiting charge for the services?
120
The limiting charge for Medicare-covered services is the maximum amount that non-participating providers can charge beneficiaries for those services. It is the difference between the non-PAR fee schedule and the Medicare-approved amount.
In this case, the Medicare non-PAR fee schedule for the service is $80, and the standard fee for the service is $150.
To calculate the limiting charge, subtract the non-PAR fee schedule from the standard fee:
$150 - $80 = $70
Therefore, the limiting charge for the service is $70.
To determine the limiting charge for a Medicare-covered service, we need to understand a few terms:
1. Standard Fee: This is the amount considered "reasonable" for a Medicare-covered service, agreed upon by Medicare and the healthcare provider. In this case, the standard fee is $150.
2. Medicare Non-PAR Fee Schedule: This is the fee schedule established by Medicare for non-participating providers (providers who have not agreed to accept Medicare's approved amount as payment in full). The non-PAR fee for the service is $80.
3. Limiting Charge: This is the maximum amount that non-participating providers can charge above the Medicare-approved amount. It is 15% more than the Medicare-approved amount.
To calculate the limiting charge, follow these steps:
1. Subtract the Medicare non-PAR fee schedule amount from the standard fee: $150 - $80 = $70.
2. Multiply the difference by 0.15 (15%): $70 * 0.15 = $10.50.
3. Add the result to the Medicare non-PAR fee schedule amount: $10.50 + $80 = $90.50.
Therefore, the limiting charge for the services is $90.50. This means that the non-participating provider cannot charge more than $90.50 above the Medicare-approved amount for this service.