Physician office reenue for visit code 99241 has a full established rate of $72.00.Of ten different payers, there are nine different contracted rates, as follows:


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

      Rate for illustration only  




Set up a worksheet with four columns: Payer, Full Rate, Contracted Rate, and Contractual Allowance.

For each payer, enter the full rate and the contracted rate.

For each payer compute the contractual allowance.The first payer has been computed below:

                       Full Rate                      Contracted Rate               Contractual Allowance

Payer              Rate            (less)                                    (equals)

FHP                $72.00                               $35.70                                $36.30


Sources of healthcare revenue are often grouped by payer. Thus services might be grouped as follows:

Revenue from the Medicare Program (payer=Medicare)

Revenue from the Medicaid Program (payer = Medicaid)

Revenue from Blue Cross Blue Shield ( payer = Commercial Insurance) or


Revenue from Blue Cross Blue Shield (payer= Managed Care Contract)

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