22 Jun Practice Exercise 13–III: Contractual Allowance 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
Practice Exercise 13–III: Contractual Allowance 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 $100.00. 3. The unit receives revenue from four major payers. For purposes of this exercise, as- sume the revenue volume from each represents 25% of the total. (The equal propor- tion 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?
As a follow-up to the Practice Exercise above, 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 $100.00
3. The unit receives revenue from four major payers. The number of procedures per- formed 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 con- tractual allowance per procedure for each payer? Q: How much is the total net revenue for each payer, and how much is the total con- Assignment Exercise 13–4.1: Forecast Capacity Levels Review the information in Exhibit 13-1 “Capacity Level Checkpoints for an Outpatient In- fusion Center.” The exhibit assumes three chairs and one 40-hour RN, for a realistic capac- ity level of seven patients infused per day. Required Prepare another Infusion Center Capacity Level Forecast as follows: Assume the same three infusion chairs, but add another nurse for either four or six hours per day. How would this change the daily capacity level for number of patients in- fused per day? Assignment Exercise 13–4.2 Required Prepare another Inf
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