Ace Your Health Insurance Billing Exam 2025 – Master the Art of Medical Billing Magic!

To calculate the coinsurance amount the patient must pay, it's essential to understand how Medicare applies coinsurance against the approved fee schedule rather than the charged amount. In this scenario, the provider submitted a charge of $75, but Medicare only recognizes $60 as the allowable amount under its physician fee schedule.

Typically, Medicare requires a coinsurance payment of 20% of the approved amount for most services. Therefore, the first step is to determine 20% of the Medicare-approved fee schedule of $60:

\[

\text{Coinsurance} = 20\% \times 60 = 0.20 \times 60 = 12

\]

This means the patient would be responsible for a coinsurance payment of $12. This amount reflects what Medicare expects the patient to pay after their coverage is applied, providing the correct context for what patients can expect regarding their financial obligations.

Other answers do not meet the calculation derived from the Medicare fee schedule, as they either exceed the allowable amount or do not correspond to the 20% coinsurance requirement. Understanding these components is crucial for effectively navigating health insurance billing practices.