Question

Physician Office Revenue for Visit Code 99214 has a full established rate of $72.00. Of ten different payers, there are nine different contracted rates, as follows:

Payer                          Contracted Rate      

FHP                                    $35.70

HPHP                                   58.85

MC                                       54.90

UND                                    60.40

CCN                                     70.20

MO                                      70.75

CGN                                    10.00

PRU                                     54.90

PHCS                                   50.00

ANA                                    45.00

Rates for illustration only.

Required

1.      Set up a worksheet with four columns: Payer, Full Rate, Contracted Rate, and Contractual Allowance.

2.      For each payer, enter the full rate and the contracted rate.

3.      For each payer, compute the contractual allowance.

The first payer has been computed below:

               Full                  Contracted          Contractual
Payer     Rate       (less)        Rate         =      Allowance
FHP      $72.00                   $35.70                 $36.30

Answer 1

For each payer, compute the contractual allowance.

Payer             Full Rate                  Contracted Rate          Contractual Allowance

FHP                 $72.00                         $35.70                                  $36.30

HPHP                72.00                           58.85                                    13.15

MC                    72.00                           54.90                                    17.10

UND                  72.00                           60.40                                    11.60

CCN                  72.00                           70.20                                      1.80

MO                    72.00                           70.75                                      1.25

CGN                  72.00                           10.00                                    62.00

PRU                  72.00                            54.90                                     17.10

PHCS              72.00                            50.00                                      22.00

ANA                72.00                           45.00                                       27.00