Question
Metropolis Family Health Center's revenue for visit code 99215 has a full established rate of $72.00. Among ten payers that work with the health center,
Metropolis Family Health Center's revenue for visit code 99215 has a full established rate of $72.00. Among ten payers that work with the health center, there are nine different contracted rates, as displayed in Figure 1 below:
On the Contractual Allowances page of the Contractual Allowances/Revenue Sources worksheet:
Enter the full rate and the contracted rate for each payer.
Compute the contractual allowance for each payer.
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 |
Cost Center | Medicare | Medicaid | Other Public Programs | Patients | Commercial Insurance | Managed Care Contracts |
ICU stay billed to employee's insurance program | ||||||
Lab test paid for by an individual | ||||||
Pathology work performed for the state | ||||||
ICU stay billed to member's health plan | ||||||
ICU stay billed for Medicare beneficiary | ||||||
Series of allergy tests run for eligible Medicaid beneficiary |
Section 2:
Complete section two (tab two on the excel spreadsheet) for the second part of the assignment. On the spreadsheet, complete columns B, C and D. In column B, indicated if the payer is publicly sponsored (taxes dollars) or privately sponsored (employer or individual purchased). In column C, list where the funds come to purchase the insurance (federal government, state government, employer expense, etc). In column D, provide a short summary of why the payer is important to healthcare providers.
Section 3:
Review the six situations located on the third tab of the downloaded spread sheet. Each situation is an unique service provided by a healthcare provider that will be reimbursed by a healthcare payer. In columns B through G for each situation, indicate with an X if the payer listed in each column will reimburse the provider for the healthcare service being provided. For example, for an "ICU stay billed to employee's insurance program," would Medicare, Medicaid, other public programs, patients, commercial insurance or managed care pay for this service? Indicate with an X if the payer would pay for this service. Remember, rows can have multiple Xs since multiple payers can reimburse for the same service.
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