If the physician’s standard fee for a service is $210.00 and the Medicare PAR fee is $115.00, what is the limiting charge for a nonparticipating (nonPAR) provider?
If the physician’s standard fee for a service is $210.00 and the Medicare PAR fee is $115.00, what is the limiting charge for a nonparticipating (nonPAR) provider?
The limiting charge for a nonparticipating (nonPAR) provider is calculated as 115% of the Medicare PAR fee. First, determine the Medicare nonPAR allowable amount, which is 95% of the Medicare PAR fee of $115.00. This calculation results in $109.25. Then, to find the limiting charge, calculate 115% of $109.25, which equals $125.63. Therefore, the correct answer is $132.25.
is it not 132.25? i thought nonpar limiting charge was 15%?
That too is my question as I also got 132.25. Someone please explain. Thanks!
Answer D is correct. The nonPar is paid 5% less, so instead of $115 it would be 109.25, then the limit charge is 15% of 109.25, so $125.63
D but not sure on this one