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Calcimator

PPO Fee Schedule Analyzer Calculator

Compare PPO reimbursement vs. UCR fees, analyze write-offs, profit margins, and evaluate dropping insurance plans.

Inputs

%

Results

Write-Off / Procedure

$60.00

≈ 12 cups of coffee

Write-Off Percentage30%
Annual Write-Offs$57,600.00
PPO Profit / Procedure-$122.50
FFS Profit / Procedure-$62.50
PPO Profit Margin-87.5%
FFS Profit Margin-31.2%
PPO Effective Hourly Rate$187.00
FFS Effective Hourly Rate$267.00
Annual Revenue Impact$37,440.00
FFS Patients to Replace37
Net Patients Needed0
How to Use This Calculator
  1. Enter your UCR Fee, PPO Allowed Fee, and Fee-for-Service Fee for the procedure being analyzed.
  2. Input Procedures per Month and Chair Time in minutes.
  3. Enter your Overhead Cost per Hour to calculate profit margins.
  4. Set the PPO Patient % to model your current payer mix.
  5. Review Write-Off per Procedure, Annual Write-Offs, and PPO vs. FFS Profit to evaluate plan participation.

How the result changes with Your UCR Fee ($)

Your UCR Fee ($)Write-Off / Procedure
500$360.00
1,750$1,610.00
3,250$3,110.00
4,500$4,360.00

What each input means

Your UCR Fee ($)
Your usual, customary, and reasonable fee for the procedure.
PPO Allowed Fee ($)
The PPO plan's maximum allowed reimbursement for this procedure.
Fee-for-Service Fee ($)
What non-PPO (fee-for-service) patients pay for this procedure.
Procedures / Month
Average number of this procedure performed per month.
Chair Time (Minutes)
Average chair time for this procedure.
Overhead Cost / Hour ($)
Practice overhead cost per clinical hour (typically $300-$500).
PPO Patient %
Percentage of patients on this PPO plan.

What each result means

Write-Off / Procedure
Contractual adjustment (UCR minus PPO allowed) per procedure.
Write-Off Percentage
Percentage of your UCR fee written off under the PPO.
Annual Write-Offs
Total annual contractual adjustments for this procedure.
PPO Profit / Procedure
Profit per procedure at PPO rate after overhead.
FFS Profit / Procedure
Profit per procedure at fee-for-service rate after overhead.
PPO Profit Margin
Profit margin on PPO-reimbursed procedures.
FFS Profit Margin
Profit margin on fee-for-service procedures.
PPO Effective Hourly Rate
Effective hourly revenue at PPO reimbursement level.
FFS Effective Hourly Rate
Effective hourly revenue at fee-for-service level.
Annual Revenue Impact
Annual revenue reduction from PPO vs. all fee-for-service.
FFS Patients to Replace
Number of FFS patients needed to replace revenue if dropping this PPO.

How this is calculated

Worked example, using the default values

  1. Identify Input Parameters
    4 parameters
    Your UCR Fee ($) = 200, PPO Allowed Fee ($) = 140, Fee-for-Service Fee ($) = 200, Procedures / Month = 80 = 7 input(s) provided
  2. Calculate Write-Off / Procedure
    Write-Off / Procedure = ucr - ppoAllowedFee
    60 = $60
  3. Calculate Write-Off Percentage
    30 = 30%
  4. Calculate Annual Write-Offs
    Annual Write-Offs = monthlyWriteOff * 12
    57600 = $57,600

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