If Joe's anesthesiologist charged $1500 while the Medicare fee schedule shows a maximum allowance of $1200, how much will Medicare Part A pay if it is his first claim in the year with a $150 deductible?

In this scenario, it's important to understand how Medicare Part A coverage works, including the role of deductibles and fee schedules. When Joe's anesthesiologist charged $1500, but the Medicare fee schedule indicated a maximum allowable amount of $1200, Medicare will base its payment on that allowed amount rather than the total charge.

Since this is Joe's first claim of the year, he first needs to satisfy the $150 deductible that applies to Medicare Part A. The deductible is subtracted from the amount that Medicare would otherwise pay based on the allowed fee. Therefore, if Medicare recognizes the $1200 allowance for the anesthesiologist's services, Joe must first pay his $150 deductible, reducing the amount that Medicare will consider for payment.

After applying the deductible, the payment calculation would look like this: Medicare would only consider the allowed amount of $1200, and with the deductible of $150 taken from that amount, there are no remaining funds for Medicare to cover. Thus, with the deductible subtracted from the allowed amount, Medicare ends up paying $0 because the deductible has consumed the full allowable amount for this claim.

This shows that the correct understanding of how deductibles and allowable amounts are factored into Medicare's payment process