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 provided.

1. Sally Jones underwent outpatient surgery to have one mole removed from her upper back. The charge was $65. The fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15. _________

2.Cherie Brown 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. _________

3.James Hill 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. _________

4.Scott Wills 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. _________

5.George Harris 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.

Answer 1

1) total cost of procedure $ 65

co insurance amount ie 20% of $ 65 = $ 13 ( 65 /100 x 20 = 13 )

fixed co payment amount $ 15

so patient should be pay $ 13 ( which is less )

2 ) total cost of x ray $75

co insurance amount ie 20% of $ 75 = 15

fixed co payment amount $ 25

so patient required to pay $ 15

3 ) total cost of glucose tolarance test $122

co insurance amount ie 20% of $122 = 24.4

fixed co payment amount $20

so patient needs to pay $20

4) total cost of the procedure $81

co insurance amount ie 20% of $ 81 = $ 16 .2

fixed co payment amount $ 25

so patient needs to pay $16.2

5)total cost of the procedure $78

co insurance amount ie 20% of $ 78= 15.6

fixed co payment amount $ 15

so patient needs to pay $15