RBRVS not handled the best way in Centricity in my opinion. Here is an idea that could make GE a leaader in the industry if done correctly.
1st - Review on how the Medicare Fee schedule works
Medicare Reimbursement Calculation
The formula for calculating Medicare reimbursement: [((RVU work x GPCI work) + (RVU practice expense x GPCI practice expense) + (RVU malpractice x GPCI malpractice)) x CF]. This is done for each procedure code. Medicare gives you everything but the GPCI – we look that up and plug it in. I will attach a copy of my RVU that I completed by downloading it off the Medicare web site.
You can find the definitions of this equation in the table below.
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RVU
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Relative Value Unit
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Composed of three components, work RVU, practice expense RVU and malpractice RVU
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GPCI
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Geographic Practice Cost Indices
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The GPCI accounts for the geographic differences associated with providing services in the 89 different localities used for payment under the Medicare physician fee schedule. Statute requires that GPCI’s be reviewed and, if necessary, adjusted at least every three years.
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CF
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Conversion Factor
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National value that converts RVU’s into payment, updated annually.
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The IDEA?
Why not up load of the current fee schedule into Centricity by CPT and handled by each section of the formula separately (work, PE, Malpractice)? Each practice would need to enter their regions GPCI. Currently Centricity you enter the whole RVU per a code. Not the work, expense and malpractice RVU. The only part of the formulae that changes from area to area is the geographic practice cost index. The GPCI's would be put in that match your region and the calculation would result in the Medicare allowable.
Also if the RVU was broke down by work, expense and malpractice you could run work reports and really see if your contracts were covering your expenses. The practices that base physician income off of work RVU’s could run reports.
I would like to run a report by facility and practice expense by insurance company. Then you could evaluate which contracts are really covering your cost.
As the Medicare fee scheudle changes it could be included in the updates.
Debi Mitchell
[email protected]
The more people who ask for this better change GE will realize we need a better fee schedule 
Posted : October 29, 2012 11:41 pm
