Medicare funding and Reibursement Essay Example | Topics and Well Written Essays - 500 words

Medicare funding and Reibursement - Essay Example The figures provided in the example have been used in the calculations. SNF base rate = 70% adjusted by area wages (hospital wage index) + 30% non-labor related portion (base adjusted for geographical factors x RUG weight). The nursing rate of $151 as per (Medpac 2008) will be used in the calculation. In terms of Participating Physician who accept assignment on each and every case the Physician bills Medicare and the patient 100% of the Medicare approved fee which is $125,000 in this case. Medicare will pay 80% which is equivalent to $100,000 and the patient will pay 20% which equals $25,000. In terms of a Non-participating Physician who accepts assignment on a case by case basis Medicare and the patient will be billed for 95% of the Medicare approved fee of $125,000. 95% is represented by $118,750. Medicare will pay 80% of $118,750 which is equal to $95,000 and the patient will pay 20% which is equal to $23,750. With respect to Non-participating Physicians who do not accept assignment the patient is billed for 115% of the Medicare approved fee of $125,000. This 115% is equal to $143,750. The patient makes the entire payment and Medicare reimburses 80% of the approved fee for non-participating physicians. Therefore, Medicare would pay 80% of $118,750 which is equal to $95,000 and the patient will bear the difference between what was paid to the Non-participating Physician which is $143,750 minus $95,000, which is equal to $48,750. Centers for Medicare & Medicaid Services. (2010). Fact Sheet: Acute Care Hospital Inpatient Prospective Payment System. Retrieved: http://www.cms.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf. Last accessed 31 Mar