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Paying for Physician Services
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Get Help Now!Mr. Smith is a 68-year-old Medicare beneficiary. He sought treatments from Dr. Johnson. Assume the following values for the services provided by Dr. Johnson:
Categories       RVU      Geographic Cost Index   Product
Work           27.45   1.092           29.98
Practice Expense   43.05   1.743           75.04
Malpractice       10.32   0.543            5.60
Conversion Factor: 64.43
1.   How much will Medicare pay Dr. Johnson if Dr. Johnson is a Medicare participating physician? How much out-of-pocket payment will Mr. Smith be responsible for?
2.   How much will Medicare pay Dr. Johnson if Dr. Johnson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Smith be responsible for?
3.   How much will Medicare pay Dr. Johnson if Dr. Johnson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Smith be responsible for?
•   Cite all sources and provide a reference list at the end of the paper.
REFERENCE/ INFO
Medicare Payment Advisory Commission. (2010). Medicare Payment Basics: Physician Services Payment System. Available at http://www.medpac.gov/documents/MedPAC_Payment_Basics_10_Physician.pdf (Retrieved 11/21/2012)
Centers for Medicare and Medicaid. (2010). Medicare Physician Fee Schedule. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at http://www.cms.gov/MLNProducts/downloads/HospitalOutpaysysfctsht.pdf (Retrieved 11/21/2012)
Wilensky, G. (2009). Reforming Medicare’s Physician Payment System. New England Journal of Medicine, 360 (7), 653-655. Available at http://healthpolicyandreform.nejm.org/?p=334 (Retrieved 11/21/2012)
