### Tab 1: Regional Telemedicine Reimbursement Policy - **Standard Consultation Rate**: Ba… — GMAT

### Tab 1: Regional Telemedicine Reimbursement Policy
- Standard Consultation Rate: Baseline reimbursement is

\$

per completed consultation. - **Rural Zone Incentive**: Consultations conducted for patients residing in designated Rural Zones receive an additional

20$ surcharge per consultation (totaling $\

per consultation). - **Audio-Only Consultation Adjustment**: Audio-only consultations are reimbursed at

50\%

of the applicable consultation rate (baseline or rural), EXCEPT when a verified technical outage is logged in Tab 3 for the consultation date, in which case the full applicable rate is granted. - **Cross-State Licensure Compliance**: Consultations for out-of-state patients are eligible for reimbursement ONLY IF out-of-state patients constitute no more than

15\%$ of the clinic's total Q3 consultations, UNLESS a formal cross-state license waiver is listed in Tab 3.

### Tab 2: Q3 Clinic Operational Summary

Clinic Name	Location Zone	Total Q3 Consultations	Out-of-State Patient %	Consultation Breakdown
Apex Health	Urban	500	12%	400 Video, 100 Audio-Only
Beacon Care	Rural	400	20%	300 Video, 100 Audio-Only
Crestview Clinic	Rural	250	10%	200 Video, 50 Audio-Only

### Tab 3: Q3 Audit Log & Compliance Exceptions
- Beacon Care: Granted a formal cross-state license waiver valid for all Q3 consultations.
- Apex Health: Logged a verified video platform technical outage on August 12 (all 100 of Apex Health's audio-only consultations occurred on this date).
- Crestview Clinic: No technical outages logged; no licensure waivers granted.

Based on the multi-tab information provided, evaluate whether the following statement is True or False:

"Beacon Care is eligible for a total Q3 reimbursement of exactly $\$$ 31,000$."

Answer: Answer

Answer

False. Beacon Care is eligible for a total Q3 reimbursement of

\$

28,000

, not

31,000

Evaluating the statement requires synthesizing policy rules from Tab 1, operational totals from Tab 2, and compliance logs from Tab 3. Beacon Care qualifies for rural pricing (

\$

per full visit) and is exempted from the cross-state cap by its Q3 waiver. Its 300 video consultations generate

24,000$. Because the verified outage in Tab 3 applied only to Apex Health, Beacon Care's 100 audio visits receive the standard $50\%$ rate reduction ($50\% \times \

80 = \

40$), adding $\

4,000

. The exact total reimbursement is

28,000$, making the statement that it equals $\

31,000$ false.

Step-by-Step Solution

Determine the applicable base reimbursement rate for Beacon Care using Tab 1 and Tab 2.

Beacon Care is located in a Rural Zone, so its rate per full consultation is

\$

60 \text{ (standard)} + \

20 \text{ (rural incentive)} = \

80$.

Tab 1 specifies an additional

\$

20$ surcharge for clinics in designated Rural Zones.

Evaluate cross-state licensure compliance using Tab 2 and Tab 3.

All 400 of Beacon Care's consultations remain eligible for reimbursement.

Although Beacon Care's out-of-state patient percentage is

20\%

(exceeding the

15\%

threshold), Tab 3 confirms Beacon Care was granted a formal cross-state license waiver for all of Q3.

Calculate reimbursement for Beacon Care's video consultations.

300 \text{ video consultations} \times \$

80 = \$

24,000

Video consultations receive the full applicable rural rate of

\$

80$ per consultation.

Determine the reimbursement rate and total for Beacon Care's audio-only consultations using Tab 1 and Tab 3.

Audio-only rate =

50\% \times \$

80 = \

40$. Reimbursement = $100 \times \

40 = \$

4,000

Tab 1 dictates that audio-only visits receive

50\%

of the applicable rate unless a technical outage is logged. Tab 3 shows that the technical outage belonged to Apex Health, not Beacon Care.

Sum the components to find total Q3 reimbursement and evaluate the statement.

Total Reimbursement =

\$

24,000 + \

4,000 = \

28,000

. The claimed total of

31,000

is incorrect.

Comparing

\$

28,000

to the statement's claim of

31,000

proves the statement is False.

Key Concept

Dichotomous Choice Evaluation with Conditional Policy Exceptions Across Multiple Data Sources

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