### 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$."

Cevap: Cevap

Cevap

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.

Adım Adım Çözüm

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.

Anahtar Kavram

Dichotomous Choice Evaluation with Conditional Policy Exceptions Across Multiple Data Sources

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

Sık Yapılan Hatalar

Konular

Bu konudan daha fazla soru