Certified Medical Assistant (CMA AAMA)Administrative: Billing, Coding and SchedulingEasy
A medical assistant is preparing to submit a claim for a patient with Medicare Part B. The patient's total charges are $300, and the Medicare allowable amount is $200. The patient has already met their annual deductible. Medicare Part B typically pays 80% of the allowable amount. What is the patient's coinsurance responsibility for this visit?
- A$40
- B$100
- C$0
- D$60
Show answer & explanationAnswer & explanation
Correct answer: A. $40
Medicare Part B pays 80% of the allowable amount, so the patient is responsible for the remaining 20% coinsurance. 20% of $200 (allowable amount) is $40.
Why the other options are wrong
- B. This represents the difference between the total charges and the allowable amount, which is often 'written off' by the provider, not charged to the patient as coinsurance.
- C. The patient is responsible for coinsurance after the deductible is met.
- D. This would be 20% of the original charge, not the allowable amount.
Medicare Part B Coinsurance
The percentage of the Medicare-approved amount that the patient is responsible for after meeting their deductible.
- Typically 20% for most services.
- Calculated based on the Medicare-approved (allowable) amount.
- Patient is responsible once the annual deductible is met.
Memory trick: Deductible first, then 80/20 split on ALLOWABLE amount.