A physician's office fee is $100 and the Medicare Part B allowed amount is $85. If the beneficiary has not met their annual deductible, how much should be billed to the patient?

A physician's office fee is $100 and the Medicare Part B allowed amount is $85. If the beneficiary has not met their annual deductible, how much should be billed to the patient?

• A. $85
• B. $100
• C. $0
• D. $15

Answer: (A)

In Medicare Part B, the patient is responsible for the deductible based on the allowed amount for the service before Medicare starts paying. The service in question has a Medicare allowed amount of 85, and the beneficiary has not yet met their annual deductible, so the patient owes that deductible amount for this visit. The charged amount of 100 doesn’t increase what the patient owes beyond the allowed amount. Therefore, the patient should be billed 85. If the deductible had already been met, the patient would then be responsible for 20% of the allowed amount (17) with Medicare covering 80% (68).

In Medicare Part B, the patient is responsible for the deductible based on the allowed amount for the service before Medicare starts paying. The service in question has a Medicare allowed amount of 85, and the beneficiary has not yet met their annual deductible, so the patient owes that deductible amount for this visit. The charged amount of 100 doesn’t increase what the patient owes beyond the allowed amount. Therefore, the patient should be billed 85. If the deductible had already been met, the patient would then be responsible for 20% of the allowed amount (17) with Medicare covering 80% (68).