Assignment Contractual Allowances, Grouping Revenue and Expenses Week 2 Hca 270

HCA/270 Health Care Finance
PART I – Contractual Allowance

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Background: Every health program negotiates particular agreements with the doctor or hospital. Each practice code
rate. Assume the settled rate for the code 99214 is $84. The doctor invoices the insurer $72 for the patient visit. Th
which it was decided that the health program would pay $45 for every patient visit. For that reason, the contractual
between the settled rate of $84 and the agreed-upon sum of $45.

Directions: Contractual allowances signify the main difference between the complete settled method rate and the ra
doctor practice depending upon the agreed-upon contractual rate. For Section I of this project, presume that every
conferred a Managed Care agreement with the doctor. The doctor has carried out 10 fresh patient physicals, one fo
each of the health programs the settled rate of $174 for practice code 98235. The agreed upon rate is mentioned i
the contractual allowance for every health program and put the outcome in Column C.
New Patient Physical Exam Code is 99385 . Established rate of $174.

Column A
Health Plan Payer

HAP
Tricare
HPM
Medicaid
Medicare
BCN PPO
BCBS
Humana
CCN
Priority Health

Column B

Column C

Contracted Rate Contractual Allowance

$110.00
$98.00
$142.95
$60.45
$70.20
$135.90
$152.00
$112.00
$74.35
$128.25

$64.00
$76.00
$31.05
$113.55
$103.80
$38.10
$22.00
$62.00
$99.65
$45.75

inance
ance
or hospital. Each practice code has an settled rate and a hired
rer $72 for the patient visit. The doctor has an agreement in
r that reason, the contractual allowance is the variation

settled method rate and the rate which will be paid to the
is project, presume that every payer shown below have
fresh patient physicals, one for every payer, and will invoice
greed upon rate is mentioned in Column B. You should find
.

There are 3 parts to this excel assignment. Use the
tabs located on your lower left side to navigate
through all of them. (hint: it says “PART I, PART II,
PART III)

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