Explain,how many procedures has your unit recorded for the period to date?

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?
Assignment Exercise 13–3

As a follow-up to the previous Practice Exercise, new assumptions are as follows:

  • 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. 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%
  • 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 = 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 allowance 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?

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