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Medical Group Management Association

Data Insights

Understand the past and present to propel your practice into the future.

Make informed decisions for your practice through insights and benchmarks from industry-leading data analysis, reports and surveys.

Charges

Gross fee-for-service charges (do not include capitation charges) [4100-4130]11

The full value, at the practice’s undiscounted rates, of all services provided to fee-for-service, discounted fee-for-service, and noncapitated patients for all payers.
Include:

  • Professional services provided by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

  • Both the professional and technical components (TC) of laboratory, radiology, medical diagnostic, and surgical procedures;

  • Drug charges, including vaccinations, allergy injections, immunizations, and chemotherapy and anti-nausea drugs;

  • Charges for supplies consumed during a patient encounter inside the practice’s facilities. Charges for supplies sold to patients for consumption outside the practice’s facilities are reported as a subset of “Revenue from the sale of medical goods and services”;

  • Facility fees. Examples of facility fees include fees for the operation of an ambulatory surgery unit or fees for the operation of a medical practice owned by a hospital where split billing for professional and facility services is utilized;

  • Charges for fee-for-service services allowed under the terms of capitation contracts;

  • Charges for professional services provided on a case-rate reimbursement basis; and

  • Charges for purchased services for fee-for-service patients. Purchased services for fee-for-service patients are defined as services that are purchased by the practice from external providers and facilities on behalf of the practice’s fee-for-service patients.

For purchased services, note the following:

  • The revenue for such services should be included in “Total net fee-for-service collections/ revenue”;

  • The cost for such services should be included, as appropriate, in “Clinical laboratory,” “Radiology and imaging” or “Other ancillary services”; and

  • The count of the number of purchased procedures for fee-for-service patients should be included in the Production tab, Number of Procedures column.

Do not include:

  • Charges for services provided to capitation patients. Such charges are included in “Gross charges for patients covered by capitation contracts”;

  • Charges for pharmaceuticals, medical supplies and equipment sold to patients primarily for use outside the practice. Examples include prescription drugs, hearing aids, optical goods, orthopedic supplies, etc. The revenue generated by such charges is included in “Revenue from the sale of medical goods and services”; or

  • Charges for any other activities that generate the revenue reported in “Revenue from the sale of medical goods and services.”

 

Adjustments to fee-for-service charges (value of services performed for which payment is not expected) [4200- 4240, 4500-4600]11

The difference between “Gross fee-for-service charges” and the amount expected to be paid by or back to patients or third-party payers. This represents the value of services performed for which payment is not expected.
Include:

  • Medicare/Medicaid charge restrictions (the difference between the practice’s full, undiscounted charge and the Medicare limiting charge);

  • Third-party payer contractual adjustments (commercial insurance and/or managed care organization);

  • Charitable, professional courtesy or employee adjustments; and

  • The difference between a gross charge and the Federally Qualified Health Center (FQHC) payment. This could be a positive or negative adjustment.

 

⭐Adjusted fee-for-service charges

Subtract "Adjustments to fee-for-service charges” from "Gross fee-for-service charges.”
 

Bad debts due to fee-for-service activity (accounts assigned to collection agencies) [6900-6920]11

The difference between “Adjusted fee-for-service charges” and the amount actually collected.
Include:

  • Losses on settlements for less than the billed amount;

  • Accounts written off as not collectible;

  • Accounts assigned to collection agencies; and

  • In the case of accrual accounting, the provision for bad debts.

 

Gross charges for patients covered by capitation contracts [4170]11

Also known as fee-for-service equivalent gross charges. The full value, at a practice’s undiscounted rates, of all covered services provided to patients covered by all capitation contracts, regardless
of payer.
Include:
Fee-for-service equivalent gross charges for all services covered under the terms of the practice’s capitation contracts, such as:

  • Professional services provided by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

  • Both the professional and technical components (TC) of laboratory, radiology, medical diagnostic, and surgical procedures;

  • Drug charges, including vaccinations, allergy injections, immunizations, and chemotherapy and antinausea drugs;

  • Charges for supplies consumed during a patient encounter inside the practice’s facilities. Charges for supplies sold to patients for consumption outside the practice’s facilities are reported as a subset of “Revenue from the sale of medical goods and services”; and

  • Facility fees. Examples of facility fees include fees for the operation of an ambulatory surgery unit or fees for the operation of a medical practice owned by a hospital where split billing for professional and facility services is utilized.

Do not include:

  • Pharmaceuticals, medical supplies, and equipment sold to patients primarily for use outside the practice. Examples include prescription drugs, hearing aids, optical goods, orthopedic supplies, etc. If such goods are not covered under the capitation contract, the revenue from these charges is included in “Revenue from the sale of medical goods and services”;

  • The value of purchased services from external providers and facilities on behalf of the practice’s capitation patients. The cost of these purchased services is included in “Purchased services for capitation patients”;

  • Charges for fee-for-service activity allowed under the terms of capitation contracts. Such charges are reported as “Gross fee-for-service charges”; or

  • Capitation revenue. If capitation charges are not tracked, leave space blank.

 

Total gross charges

Add “Gross fee-for-service charges” and “Gross charges for patients covered by capitation contracts.”

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