Question

4. Oceanside Physicians has a price of $72.00 for office visit code 99214. The negotiated fee for 10 different commercial payers is given below. Price Negotiated Contractual Projected Allowance Volume Estimated Payer Rate Revenue FHP 72.00 450 35.70 150 72.00 HPHP 58.85 UND 72.00 54.90 325 72.00 MC 60.40 240 72.00 70.20 380 CCN 72.00 70.75 MO 625 72.00 400 CGN 10.00 72.00 54.90 200 PRU 72.00 50.00 375 PHCS 150 72.00 ANA 45.00 (a). Calculate the contractual allowance for each payer. (b). Based on the projected volumes for each payer, what is the total contractual allowance (write-off) for Oceanside Physicians from visit code 99214. (c). Based on the projected volumes for each payer, calculate the estimated revenue from each payer (d). What is the total expected revenue for Oceanside Physicians from visit code 99214?

Answer 1

Solution Negotiated Contractual Price Payer Allwoance Rate FHP 72.00 35.70 36.30 HPHP 72.00 58.85 13.15 UND 72.00 54.90 17.10 MC 72.00 60.40 11.60 CCN 72.00 70.20 1.80 MO 72.00 70.75 1.25 CƠN 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 Required b:Based on the proiected olumes for each payer, what is the total contractu allowance (write-off for Oceanside Physicians from

Contractual Projected Total Contractual Payer Allwoance Volume Allowance FHP 36.30 450 16,335.00 HPHP 13.15 150 1,972.50 UND 17.10 325 5,557.50 MC 11.60 240 2,784.00 CCN 1.80 380 684.00 MO 1.25 625 781.25 CƠN 62.00 400 24 800.00 3.420.00 PRU 17.10 200 PHCS 22.00 375 8,250.00 ANA 27.00 150 4,050.00 Totals 68,634.25 Required c Based on the proiected volumes for each payer, calculate

Projected Total estimated Price Payer Volume Revenue 450 FHP 72.00 32,400.00 HPHP 72.00 150 10,800.00 UND 72.00 325 23,400.00 MC 72.00 240 27,360.00 CCN 72.00 380 MO 72.00 625 45,000.00 400 CƠN 72.00 28,800.00 PRU 72.00 200 14,400.00 PHCS 72.00 375 27,000.00 ANA 72.00 150 10,800.00 Totals $237,240.00 Required d: What is the total xpected revenue for Oceanside e 99214 from VIS $237,240.00 Total amount billed Less: Contractual Allowance ($68,634.25 Total expected revenue from visit code 99214 168,605.75