Question

Physician office revenue for visit code 99214 has a full established rate of $72.00.

Of 10 different payers, there are 9 different contracted rates, as indicated in the template provided below.

For each payer, compute the contractual allowance using the template provided:

GHA 1 Template          
          
COLUMN   A   B   C=A-B
PAYER   FULL RATE   CONTRACTED RATE   CONTRACTUAL ALLOWANCE
FHP   $72.00    $37.00   
HPHP   $72.00    $56.85   
MC   $72.00    $44.90   
UND   $72.00    $62.40   
CCN   $72.00    $70.23   
MO   $72.00    $61.75   
CGN   $72.00    $9.00   
PRU   $72.00    $57.90   
PHCS   $72.00    $48.00   
ANA   $72.00    $43.00   

Answer 1

Contractual allowance or contractual adjustment is the difference between the amount charged for a service provided by a healthcare provider and the amount to be paid according to the terms and conditions of the contract signed by him with the insurers and the government.

According to the question, the following table gives the calculation of contractual allowance.

Column A	Column B	Column C	Column D
Payer	Full Rate	Contracted Rate	Contractual Allowance (Column A - Column B)
FHP	$72.00	$37.00	$35
HPHP	$72.00	$56.85	$15.15
MC	$72.00	$44.90	$27.10
UND	$72.00	$62.40	$9.60
CCN	$72.00	$70.23	$1.77
MO	$72.00	$61.75	$10.25
CGN	$72.00	$9.00	$63.00
PRU	$72.00	$57.90	$14.10
PHCS	$72.00	$48.00	$24.00
ANA	$72.00	$43.00	$29.00