Practice Exercise 13 III:  Contractual Allowance

Assumptions:
1. Your unit’s gross charges for the period to date amount to $200,000.
2. The uniform gross charge for each procedure in your unit is $100.
3. The unit receives revenue from four major payers. For purposes of this exercise, assume the revenue volume from each represents 25% of the total. (The equal proportion is unrealistic, but serves the purpose for this exercise.)
4. The following contractual payment arrangements are in effect for the current period. The percentage of the gross charge that is currently paid by each payer is as follows: Payer 1 = 90% Payer 2 = 80% Payer 3 = 70% Payer 4 = 50%
Q: How many procedures has your unit recorded for the period to date?
Q: Of these, how many procedures are attributed to each payer?
Q: How much is the net revenue per procedure for each payer, and how much is the contractual allowance per procedure for each payer?

Nursing assignments


 

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