Question

Under the OPPS, Medicare allows patients to pay either a coinsurance amount (20 percent of the charge for procedures and services) or a fixed copayment amount, whichever is less. For each of the following cases, calculate the amount the patient is required to pay to the hospital for the outpatient service. Note: In each of the following cases, the patient has already met the annual deductible required by the payer.  

1.Jennifer Horton underwent an outpatient chest x-ray that cost $75. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $25.

Patient payment:

2.Ethan Frame underwent an outpatient oral glucose tolerance test. The charge for this procedure was $122. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $20.

Patient payment:

3.Mackenzie Westmore underwent toenail removal as an outpatient. The charge was $81. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $25.

Patient payment:

4. Theo Carver had a suspicious lesion removed from his left temple as an outpatient. The charge was $78. The fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15.

Patient payment:

Answer 1

1. 20% of the cost of chest X-ray is = 20/100*75= $15

Since $15 is less than fixed copayment of $25, so the patient's payment will be $15.

2 20% of glucose tolerance test is 20/100*122= $24.4

As $24.4 is greater than fixed copayment of $20. So the patient payment will be $20 which is the fixed copayment.

3. The patient payment will be $16.2 as 20/100*81 is lesser than fixed copayment of $25.

4. 20% of $78 is $15.6 which is greater than the fixed copayment of $15. So the patient will pay the fixed copayment of $15.