Question

Calculate the following amounts for a nurse practitioner who bills Medicare under their own NPI.

Submitted charge                                                                   $75

Medicare allowed amount (MPFS)                                         $60

Nurse practitioner allowed amount                                         $    

(80% of office charge or 85% of MPFS whichever is lower)

Medicare payment (80% of the allowed amount)                  $       

Coinsurance amount                                                              $      

Provider write-off                                                                    $      

Answer 1

Submitted charge                                                                   $75

Medicare allowed amount (MPFS)                                         $60

Nurse practitioner allowed amount                                          51$    

(80% of office charge or 85% of MPFS whichever is lower)

Medicare payment (80% of the allowed amount)                    41$       

Coinsurance amount                                                               10$      

Provider write-off                                                                       24$      

If the APP bills directly to Medicare, with his/her name and NPI on the claim form, then the payment is reduced by to 85 percent of the MPFS allowable, hence the amount would be 85% of 60$

Medicare payment- 80% of 51$

If coinsurance amount is 20%, then the patient would pay 20% of the amount and rest will be borne by the insurance company which would be 20% of 51$

A provider write-off is the amount eliminated from the fees for a service provided by a facility that serves as a healthcare provider for an insurance company. Here the charge was 75$ and nurse practitioner allowed was 51$ so the amount would be 24$