Health & Medical Homework Help
Health Insurance Calculations – Tricare Participating Provider There is a video resource that demonstrates a similar scenario. More information is available to you in Chapter 9 of your text. Specifi
Health Insurance Calculations – Tricare Participating Provider
There is a video resource that demonstrates a similar scenario. More information is available to you in Chapter 9 of your text. Specific tips are:
· Participating provider receives the full amount listed on the Physician’s Fee Schedule (PFS).
· Limiting charge = the highest amount the provider can collect from the patient & insurance = PFS x 115%
Fill in the blanks in the following payment situations:
1A
Participating Provider no remaining deductible
Physician’s standard fee $ 320
TRICARE fee $ 235
Patient pays 20% $
TRICARE pays 80% $
Provider adjustment (write-off) $
1B
Participating Provider with remaining deductible
Physician’s standard fee $320
TRICARE fee $235
Patient pays remaining deductible ($100) $
Patient pays 20% remaining charge $
TRICARE pays 80% remaining charge $
Provider adjustment (write-off) $