Assume the patient has already met his or her deductible and that the physician is a Medicare participating (PAR) provider. The physician’s standard fee for the services provider is $120.00. Medicare’s PAR fee is $60.00. How much reimbursement will the physician receive from Medicare?
If the physician is a Medicare participating (PAR) provider, they agree to accept Medicare's approved amount as full payment. Medicare usually pays 80% of the approved amount after the deductible has been met, and the patient is responsible for the remaining 20%. In this case, Medicare’s PAR fee is $60.00. Therefore, Medicare pays 80% of $60.00, which is $48.00. Hence, the physician will receive $48.00 from Medicare.
C - Medicare’s PAR fee is $60.00 x 80 Medicare pays to provider = 4,800 / 100 = 48
Participating (PAR) providers agree to take assignment, 80 percent that Medicare pays the provider and 20 percent that is applied to the patient's co-payment, as payment in full for all Medicare covered services for the calendar year.