How much is the total net revenue for each payer, and how much is the total contractual allowance for each payer?

HEALTH SCIENCES AND MEDICINE

Assignment Exercise 13–3 PERFORM A CONTRACTUAL ALLOWANCE:
• 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.
• 3. The unit receives revenue from four major payers. The number of procedures performed 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 contractual allowance per procedure for each payer?
• Q: How much is the total net revenue for each payer, and how much is the total contractual allowance for each payer?
Assignment Exercise 13–4.1: Forecast Capacity Levels
Review the information in Exhibit 13–1. The exhibit assumes three chairs and one 40-hour RN, for a realistic capacity level of seven patients infused per day.
Exhibit 13–1 – illustrates the array of elements that should be taken into account when computing maximum capacity levels. This computation is important because your forecast should take maximum capacity into account. (Alternative assumptions can also be made, of course. See the sensitivity analysis discussion in a following chapter.)
Exhibit 13–1 Capacity Level Checkpoints for an Outpatient Infusion Center
Outpatient Infusion Center Capacity Level Checkpoints
# infusion chairs ———————3 chairs
# staff ———————1 RN
# weekly operating hours ———————40 hours
# of hours per patient infusion ———————average 2 hours (for purposes of this example)

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 infused per day?


 

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