13-3 1. your unit\'s gross charges for the period to date amount to $20,000 2. t
ID: 2625478 • Letter: 1
Question
13-3 1. your unit's gross charges for the period to date amount to $20,000 2. the uniform gross charge for each procedure in your unit is $100.00 3. the unit receives revenue from major payers. the number of procedures performed for the period totals 2,000. of that total, the number of procedures per payer (stated as a percentage) is as follows: payer 1=30% payer 2=40% payer 3=20% payer 4=10% 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= 80% (Medicare) payer 2 = 70% ( commercial managed care plans) payer 3 = 50% (Medicaid) payer 4 = 90% (self pay ) Q: 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 appowance per procedure for each payer? Q: How much is the total net revenue for each payer, and how much is the total contractual allowance for each payer?
Explanation / Answer
Answer:
The unit has performed a total of 2,000 procedures. Of these,
Payer 1 = 30% x 2,000 = 600 procedures
Payer 2 = 40% x 2,000 = 800 procedures
Payer 3 = 20% x 2,000 = 400 procedures
Payer 4 = 10% x 2,000 = 200 procedures
____
Proof Total = 2,000
Answer:
The computation is as follows:
Payer #
Gross Charges
% Paid by Each Payer
Net Revenue per Procedure
Contractual Allowance per Procedure
1
$100.00
80%
$80.00
$20.00
2
$100.00
70%
$70.00
$30.00
3
$100.00
50%
$50.00
$50.00
4
$100.00
90%
$90.00
$10.00
Answer:
The total net revenue computation for each payer is as follows:
Payer #
Number of Procedures
Times
Net Revenue
per Procedure
per Payer
Equals
Total Net Revenue
per Payer
1
600
$80.00
$48,000
2
800
$70.00
$56,000
3
400
$50.00
$20,000
4
200
$90.00
$18,000
Total
2,000
$142,000
The total contractual allowance computation for each payer is as follows:
Payer #
Number of Procedures
Times
Contractual Allowance
per Procedure
per Payer
Equals
Total
Contractual Allowance
per Payer
1
600
$20.00
$12,000
2
800
$30.00
$24,000
3
400
$50.00
$20,000
4
200
$10.00
$ 2,000
Total
2,000
$58,000
Proof Total: $142,000 plus $58,000 = $200,000
Payer #
Gross Charges
% Paid by Each Payer
Net Revenue per Procedure
Contractual Allowance per Procedure
1
$100.00
80%
$80.00
$20.00
2
$100.00
70%
$70.00
$30.00
3
$100.00
50%
$50.00
$50.00
4
$100.00
90%
$90.00
$10.00
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