Professional services
Medical Practice Visit Value Calculator
Works what a visit is actually worth, where the charge has little to do with it.
Result
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.
Get a Free Business AuditHow the calculation works
The payment expected per visit after contractual adjustment, less the cost of delivering it, giving contribution per visit. The charge on the fee schedule is not the revenue: each payer pays its own allowed amount, so the value of a visit depends on which payer the patient has, and a practice's average visit value is a function of its payer mix more than of its pricing.
What moves the number
- Payer mix and the allowed amounts in each contract.
- Visit type and the services actually provided.
- Cost of delivery including provider and staff time.
- Denial and rework rate on that visit type.
Where this one goes wrong
Coding has to reflect the services actually provided and documented, and that is a compliance requirement rather than a revenue lever: selecting codes to increase reimbursement beyond what the documentation supports is fraud, with consequences far exceeding the amounts involved. The legitimate improvements are documenting fully what was genuinely done, reducing denials, and understanding which payer contracts pay adequately for the visit types the practice performs most.
Before you quote
- Code to what was provided and documented, nothing else.
- Calculate visit value by payer, not blended.
- Compare contribution per visit against the time it consumes.
Where the rules come from
Questions
About this calculator
Why does the same visit produce different revenue?
Because each payer pays its own contracted allowed amount regardless of the practice's charge. Average visit value is therefore a function of payer mix more than of pricing, which is why the charge on the fee schedule tells you very little.
Can coding be used to raise revenue?
Only by documenting accurately what was genuinely provided. Selecting codes beyond what the documentation supports is fraud, and the consequences far exceed the amounts involved. The legitimate levers are complete documentation, fewer denials, and better contracts.
Should low-value visit types be dropped?
Only after comparing contribution against the time consumed, since a modest payment for a short visit can beat a larger payment for a long one. The clinical appropriateness question sits above the economics and is not a calculator's to answer.
The formula
blended value = each payer's collected value weighted by its share of the mix
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How to use this calculator
- Charge per visit ($). Enter your own figure; the page starts at $265.
- Commercial insurance share (%). Enter your own figure; the page starts at 45%.
- Commercial pays this share of charges (%). Enter your own figure; the page starts at 62%.
- Government programme share (%). Enter your own figure; the page starts at 38%.
- Government pays this share of charges (%). Enter your own figure; the page starts at 42%.
- Self pay share (%). Enter your own figure; the page starts at 17%.
The result updates as you type, so you can try a figure, see what it does to blended value per visit, and change it back. Nothing you enter is sent anywhere or saved.
A worked example
These are the figures the calculator opens with. Every number in the results column below is produced by the same calculation the page runs, so you can follow it through before putting your own figures in.
What goes in
| Input | Value |
|---|---|
| Charge per visit | $265 |
| Commercial insurance share | 45% |
| Commercial pays this share of charges | 62% |
| Government programme share | 38% |
| Government pays this share of charges | 42% |
| Self pay share | 17% |
| Self pay actually collected | 55% |
What comes out
| Result | Value |
|---|---|
| Blended value per visit main result | $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 $111.30 from government programmes.
How sensitive the answer is
Holding everything else steady and changing only charge per visit, this is what happens to blended value per visit. It is worth knowing which of your inputs the answer actually hinges on, and which barely move it.
| Charge per visit ($) | Blended value per visit |
|---|---|
| $133 | $70.77 |
| $199 | $105.89 |
| $265 example above | $141.01 |
| $398 | $211.78 |
| $530 | $282.01 |
Every other input is held at the example value while this one changes, which is not how a real job behaves. Treat it as a guide to which number matters most, not as five separate quotes.
What each figure means
- Charge per visit ($)
- A money amount, starting at $265.
- Commercial insurance share (%)
- A percentage, between 0 and 100, starting at 45%.
- Commercial pays this share of charges (%)
- A percentage, between 0 and 100, starting at 62%.
- Government programme share (%)
- A percentage, between 0 and 100, starting at 38%.
- Government pays this share of charges (%)
- A percentage, between 0 and 100, starting at 42%.
- Self pay share (%)
- A percentage, between 0 and 100, starting at 17%.
- Self pay actually collected (%)
- A percentage, between 0 and 100, starting at 55%.
What the results tell you
| Result | What it is |
|---|---|
| Blended value per visit | The headline result. A money figure. |
| Commercial visit value | A money figure. |
| Government visit value | A money figure. |
| Self pay visit value | A money figure. |
| Blended share of charges collected | A percentage. |
Keep going
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