A physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts?

A physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts?

• A. $85
• B. $100
• C. $15
• D. $0

Answer: (A)

Medicare Part B requires the patient to pay the deductible before Medicare coverage begins, and the patient’s responsibility is based on the allowed amount for the service. The provider cannot bill the patient more than the allowed amount for a Medicare-covered service while the deductible is still unmet. Here, the physician’s charge is 100, but Medicare’s allowed amount is 85. Since the beneficiary has not met the annual deductible, the patient is responsible for paying up to the deductible, which in this case equals the allowed amount. Therefore, the office should bill the patient 85. The remaining 15 cannot be billed to the patient in this situation because it exceeds the allowed amount, and Medicare has not yet begun its payment due to the deductible not being met.

Medicare Part B requires the patient to pay the deductible before Medicare coverage begins, and the patient’s responsibility is based on the allowed amount for the service. The provider cannot bill the patient more than the allowed amount for a Medicare-covered service while the deductible is still unmet.

Here, the physician’s charge is 100, but Medicare’s allowed amount is 85. Since the beneficiary has not met the annual deductible, the patient is responsible for paying up to the deductible, which in this case equals the allowed amount. Therefore, the office should bill the patient 85. The remaining 15 cannot be billed to the patient in this situation because it exceeds the allowed amount, and Medicare has not yet begun its payment due to the deductible not being met.