RBRVS, RVUs and Fees tables
The following table appears when you select the RVUs tab in the CPT book screen. The table provides geographically adjusted Medicare and UCR fee data and other parameters including Clinical Lab Fees, Global Surgery periods, Ambulatory Surgical Center procedure's group number and dollar amount, and modifiers indicators.HCPCS Edits tables with the Current DME fees for your location are also included.
The Fee Schedule Module
The Fee Schedule subsystem module allows you to create, copy, delete and maintain unlimited number of fee tables. Clicking on the Fee Schedule icon at the Tool bar activates the Fee Schedule subsystem. In general, a Fee Schedule is a table of procedure codes, fees and volume (or frequencies) for a selected period of time. It is possible to have multiple Fee Schedules.
You may setup a different fee schedule for each of the following cases:
- All your practice procedures
- For each physician in your practice
- For certain insurance company to learn about their conversion factor and payment behavior
- For a Managed Care contract
- For Capitation data (see Capitation VS Fee-for-Service)
Once a fee schedule table is entered, meaningful information can be extracted, such as the Procedure Conversion Factor (the CF column) which is simply the quotient of the procedure fee divided by the RVU. It shows how consistent the fees in the table are. Fees should be around the same price per unit or conversion factor. It would not be consistent for example to have one procedure $100 per unit while the other is $40 per unit.
Maintaining the Fee Schedule
Data can be added to a Fee Schedule table in a variety of ways. The following screen enables you to copy a range of codes into a fee schedule as well as to assign their fees and volume. You may define the data source that will be used by the Copy functions. Data can be copied directly from the CPT RVUs table or from another fee schedule table.
You may setup fees and volume according to following choices:
- To MDCR Value - Setup all procedure fees to the Medicare fees
- To UCR 75% Value - Setup the fees to the 3M Health Information Systems' UCR 75% Percentile
- To RVU x - Multiply the RVU's conversion factor you designate
- Multiply by - Multiply all procedure fees by a specific number
- Change on ± - Add or subtract a specific amount to all procedure fees
Fee Schedule totals
The totals provide you at a glance summary data regarding the Fee Schedule:
Total Procedures - The sum of the different procedures (CPT's) in the fee schedule
Total RVU's - The total RVU's in the fees schedule. Calculated as the sum of all procedure RVU multiplied by the volume
RVU Per patient - The sum of the RVU's divided by the number of patients
RVU Per visit - The sum of the RVU's divided by the number of visits
Conversion Factor - The Fee Schedule Conversion Factor is a weighted average for all the procedures in the fee schedule. It indicates the price charges for one RVU. The Fee schedule Conversion Factor will be biased towards the procedures you perform most. A weighted average is an adjusted average which gives greater consideration to the procedures that are performed more often. So more frequently performed procedures contribute greater to the calculation of the average, i.e., the weighted average is volume sensitive. Every time you add, delete, or change fee or volume value for a CPT procedure, your fee schedule Conversion Factor will most likely change.
