What is the out-of-pocket expense for a patient if the PAR Medicare Fee Schedule amount is $200.00 and they are responsible for 20% coinsurance?

Prepare for the RHIA Reimbursement Test with multiple choice questions, each accompanied by hints and explanations. Ace your exam with confidence!

To determine the out-of-pocket expense for the patient, you first need to calculate the amount of coinsurance based on the PAR Medicare Fee Schedule amount of $200.00. The patient is responsible for 20% of that fee.

To find the amount the patient must pay, you multiply the total fee by the coinsurance percentage:

Out-of-pocket expense = Total Fee x Coinsurance Percentage

Out-of-pocket expense = $200.00 x 20%

Out-of-pocket expense = $200.00 x 0.20

Out-of-pocket expense = $40.00

This calculation shows that the patient’s out-of-pocket expense is $40.00, which is why this choice is correct. This means they will need to pay $40.00 for the service after their insurance has applied its coverage, underlining the importance of understanding how coinsurance works in healthcare billing.