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Medical Practice Visit Value Calculator

What a visit is actually worth across a payer mix, after adjustments and collection.

Your numbers

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Result

Blended value per visit $141.01
Commercial visit value $164.30
Government visit value $111.30
Self pay visit value $145.75
Blended share of charges collected 53.21%
A visit charged at $265.00 is worth $141.01 blended across the payer mix, which is 53.21% of the charge. Commercial pays $164.30 against $111.30 from government programmes.

Practice administration arithmetic, not clinical or billing advice. Payer contracts, coding rules and the regulations governing patient communication and cancellation policies all vary and change. Nothing here bears on clinical decisions or on how any individual patient should be cared for. Payer mix has more effect on practice economics than almost anything a practice controls, and a shift of a few points between commercial and government payers moves revenue materially at identical volume. Contracted rates are set by negotiation and by fee schedules, not by what is charged.

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Questions

About this calculator

Why does payer mix matter so much?

Because contracted rates differ substantially between payers for identical work. Two practices seeing the same number of patients for the same conditions can have very different revenue.

Does raising charges raise revenue?

Not for contracted payers, who pay the contracted rate regardless. It affects only self-pay and any payer paying a percentage of billed charges, which is increasingly rare.

The formula

blended value = each payer's collected value weighted by its share of the mix

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