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Review on Paying for Physician Services

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Paying for Physician Services – Overview

Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:

Categories

RVU

Geographic Cost Index

Product

Work

27.45

1.092

29.98

Practice Expense

43.05

1.743

75.04

Malpractice

10.32

0.543

5.60

Conversion Factor: 64.43

1.  How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?

2. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?

3. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?

Medicare Payment Advisory Commission. (2016). Medicare Payment Basics:
Hospital Acute Inpatient Services Payment System. Available at: http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_hospital_final.pdf

Medicare Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_opd_final.pdf?sfvrsn=0

Medicare Payment Advisory Commission. (2014). Physician and Other Health Professionals Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_physician_final.pdf?sfvrsn=0

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