Reimbursement Homework Help

Reimbursement HW

Exercise 1

Jane Doe is an 83-year-old patient who only has Medicare Part A insurance. After reviewing the following information, answer the questions regarding her listed hospitalizations.




01/01 01/13 $912.00
03/20 03/30 $912.00
07/04 11/02 $21,888 ($912 + 6,840 + 14, 136)
12/01 12/05 $2,280



  1. How many benefit periods were used during this calendar year?





  1. Were any lifetime reserve days used during this period of time? If so, how many?






  1. If lifetime reserve days were used, how many does the patient have left to be used at a later date?





  1. How many times was the patient required to pay a hospital deductible during this time period?





  1. Following this last hospital admission, Jane was transferred to a skilled nursing facility (SNF) and remained there for continued treatment for 22 days.


  1. How much was Jane required to pay for her SNF care for days 1–20?





  1. How much was she required to pay for the remainder of her SNF stay if the copay is $114?





  1. After Jane’s discharge from the skilled facility, she received home health care as prescribed by her physician for 14 days. During this time period, she met all Medicare’s medical necessity criteria for her care. How much did the patient have to pay for her home health care?





Exercise 4

Use the tables below to answer the following questions. The first portion of part b “St. Louis” has been completed for you.




The national conversion factor for 2011 is $33.9764.







  1. How much can a physician in St. Louis bill Medicare for an office visit (99203) for a new patient with a detailed history and physical and low-complexity medical decision making (assuming the patient has met any deductible for the year)?

Office visit (99203)


















Fee Schedules by Provider Type


Fill in the blanks with the correct dollar amounts as indicated



PAR Provider
Physician’s fee $180.00
MFS $105.00
Medicare pays 80% of MFS or _____________
Patient pays 20% of MFS or _____________
Physician write-off _____________
Non PAR accepts assignment
Physician’s fee $180.00
MFS $105.00
Medicare NonPAR fee (95% of MFS) _____________
Medicare pays 80% of nonPAR fee _____________
Patient pays 20% of nonPAR fee _____________
Physician write-off _____________


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