HSA 525-Contractual Allowances
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 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 | (equals) | Allowance |
| FHP | $72.00 | $35.70 | $36.30 |
Example 4B: Revenue Sources and Grouping Revenue
Sources of healthcare revenue are often grouped by payer. Thus, services might be grouped as follows:
- Revenue from the Medicare Program (payer = Medicare)
- Revenue from the Medicaid Program (payer = Medicaid)
- Revenue from Blue Cross Blue Shield (payer = Commercial Insurance)
- or
- Revenue from Blue Cross Blue Shield (payer = Managed Care Contract)
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