Table 9D: Patient Related Revenue
Puerto Rico Data
21 Awardees
| Line | Payer Category | Charges | Collections | |||||
|---|---|---|---|---|---|---|---|---|
| Full Charges This Period (a) $ |
% of Payer | % of Total | Amount Collected This Period (b) $ |
% of Payer | % of Total | % of Charges | ||
| 1. | Medicaid Non-Managed Care | $109,485 | 0.03% | 0.02% | $98,150 | 0.03% | 0.02% | 89.65% |
| 2a. | Medicaid Managed Care (capitated) | $185,884,347 | 55.96% | 38.96% | $208,804,649 | 67.23% | 50.98% | 112.33% |
| 2b. | Medicaid Managed Care (fee-for-service) | $146,196,102 | 44.01% | 30.64% | $101,697,740 | 32.74% | 24.83% | 69.56% |
| 3. | Total Medicaid (Sum of Lines 1 + 2a + 2b) | $332,189,934 | 100.00% | 69.63% | $310,600,539 | 100.00% | 75.83% | 93.50% |
| 4. | Medicare Non-Managed Care | $6,639,279 | 7.88% | 1.39% | $3,183,370 | 4.99% | 0.78% | 47.95% |
| 5a. | Medicare Managed Care (capitated) | $24,379,010 | 28.93% | 5.11% | $20,319,901 | 31.85% | 4.96% | 83.35% |
| 5b. | Medicare Managed Care (fee-for-service) | $53,237,276 | 63.19% | 11.16% | $40,296,663 | 63.16% | 9.84% | 75.69% |
| 6. | Total Medicare (Sum of Lines 4 + 5a + 5b) | $84,255,565 | 100.00% | 17.66% | $63,799,934 | 100.00% | 15.58% | 75.72% |
| 7. | Other Public, including Non-Medicaid CHIP, Non-Managed Care | $0 | 0.00% | 0.00% | $0 | 0.00% | 0.00% | |
| 8a. | Other Public, including Non-Medicaid CHIP, Managed Care (capitated) | $0 | 0.00% | 0.00% | $0 | 0.00% | 0.00% | |
| 8b. | Other Public, including Non-Medicaid CHIP, Managed Care (fee-for-service) | $0 | 0.00% | 0.00% | $0 | 0.00% | 0.00% | |
| 8c. | Other Public, including COVID-19 Uninsured Program | $70,510 | 100.00% | 0.01% | $62,863 | 100.00% | 0.02% | 89.15% |
| 9. | Total Other Public (Sum of Lines 7 + 8a + 8b + 8c) | $70,510 | 100.00% | 0.01% | $62,863 | 100.00% | 0.02% | 89.15% |
| 10. | Private Non-Managed Care | $38,885,388 | 100.00% | 8.15% | $23,234,031 | 100.00% | 5.67% | 59.75% |
| 11a. | Private Managed Care (capitated) | $0 | 0.00% | 0.00% | $0 | 0.00% | 0.00% | |
| 11b. | Private Managed Care (fee-for-service) | $0 | 0.00% | 0.00% | $0 | 0.00% | 0.00% | |
| 12. | Total Private (Sum of Lines 10 + 11a + 11b) | $38,885,388 | 100.00% | 8.15% | $23,234,031 | 100.00% | 5.67% | 59.75% |
| 13. | Self-Pay | $21,694,642 | 100.00% | 4.55% | $11,909,596 | 100.00% | 2.91% | 54.90% |
| 14. | TOTAL (Sum of Lines 3 + 6 + 9 + 12 + 13) | $477,096,039 | 100.00% | $409,606,963 | 100.00% | 85.85% | ||
| Line | Payer Category | Retroactive Settlements, Receipts, and Paybacks(c) | Adjustments | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Collection of Reconciliation /Wraparound Current Year(c1) $ |
Collection of Reconciliation /Wraparound Previous Years(c2) $ |
Collection of Other Payments: P4P, Risk Pools, etc.(c3) $ |
Penalty/ Payback (c4) $ |
Net Retros $ |
Net Retros % of Charges | Adjustments (d) $ |
Adjustments % of Charges | ||
| 1. | Medicaid Non-Managed Care | $0 | $0 | $0 | $0 | $0 | 0.00% | $6,850 | 6.26% |
| 2a. | Medicaid Managed Care (capitated) | $59,539,221 | $47,394,257 | $4,522,802 | $4,942 | $111,451,338 | 59.96% | ($22,920,302.00) | -12.33% |
| 2b. | Medicaid Managed Care (fee-for-service) | $2,774,414 | $1,820,722 | $0 | $0 | $4,595,136 | 3.14% | $31,172,480 | 21.32% |
| 3. | Total Medicaid (Sum of Lines 1 + 2a + 2b) | $62,313,635 | $49,214,979 | $4,522,802 | $4,942 | $116,046,474 | 34.93% | $8,259,028 | 2.49% |
| 4. | Medicare Non-Managed Care | $80,683 | $0 | $0 | $0 | $80,683 | 1.22% | $1,056,101 | 15.91% |
| 5a. | Medicare Managed Care (capitated) | $177,219 | $320,201 | $60,272 | $0 | $557,692 | 2.29% | $4,059,109 | 16.65% |
| 5b. | Medicare Managed Care (fee-for-service) | $0 | $0 | $0 | $0 | $0 | 0.00% | $10,984,936 | 20.63% |
| 6. | Total Medicare (Sum of Lines 4 + 5a + 5b) | $257,902 | $320,201 | $60,272 | $0 | $638,375 | 0.76% | $16,100,146 | 19.11% |
| 7. | Other Public, including Non-Medicaid CHIP, Non-Managed Care | $0 | $0 | $0 | $0 | $0 | $0 | ||
| 8a. | Other Public, including Non-Medicaid CHIP, Managed Care (capitated) | $0 | $0 | $0 | $0 | $0 | $0 | ||
| 8b. | Other Public, including Non-Medicaid CHIP, Managed Care (fee-for-service) | $0 | $0 | $0 | $0 | $0 | $0 | ||
| 8c. | Other Public, including COVID-19 Uninsured Program | $0 | $0 | $0 | 0.00% | $8,321 | 11.80% | ||
| 9. | Total Other Public (Sum of Lines 7 + 8a + 8b + 8c) | $0 | $0 | $0 | $0 | $0 | 0.00% | $8,321 | 11.80% |
| 10. | Private Non-Managed Care | $0 | $0 | $0 | 0.00% | $9,344,589 | 24.03% | ||
| 11a. | Private Managed Care (capitated) | $0 | $0 | $0 | $0 | ||||
| 11b. | Private Managed Care (fee-for-service) | $0 | $0 | $0 | $0 | ||||
| 12. | Total Private (Sum of Lines 10 + 11a + 11b) | $0 | $0 | $0 | 0.00% | $9,344,589 | 24.03% | ||
| 13. | Self-Pay | ||||||||
| 14. | TOTAL (Sum of Lines 3 + 6 + 9 + 12 + 13) | $62,571,537 | $49,535,180 | $4,583,074 | $4,942 | $116,684,849 | 24.46% | $33,712,084 | 7.07% |
| Line | Sliding Fee Discounts (e) $ |
Bad Debt Write-Off (f) $ |
|
|---|---|---|---|
| 13. | Self-Pay | $5,266,176 | $608,576 |
Footnotes
'-' Data cannot be calculated or has been suppressed for confidentiality purposes.
Cells that are shaded blue represent data that was not reported or null values.
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