Question

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) $

          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)                                               $

Added by Montserrat M.

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