FeeCalc Help System Table of Contents

The Contents lists the Help topics available for FeeCalc - the RBRVS Fee Calculator.

To learn how to use Help, press F1 or choose Using Help from the Help menu

General

File Menu Commands

Edit Menu Commands

View Menu Options

Screen Layouts

Main Screen

Table Dialog

CPT Information Dialog

RBRVS Concepts

Physician Payment Reform

Resource Based Relative Value Scale (RBRVS)

Using Relative Value Units (RVUs) to Determine Procedure Pricing

Geographic Practice Cost Indices (GPCIs)

Relative Value Systems

Common Acronyms

Support

Technical Support

The Association of Shareware Professionals


File Menu Commands

New

Clears the workspace.  Note that this command does not clear the Table Information data.

Open...

Clears the workspace and opens a FeeCalc File.  FeeCalc files may be either Comma Separated Value (*.CSV) files or Tab Separated (*.TXT) files.

Save/Save As...

Saves the current data as a *.CSV or *.TXT file.  Save is only available after a file has been defined by either an Open... or previous SaveAs... command.

Print

Prints the current view to the MS-Windows default printer.  Views may include Detail and/or Notes.

Exit

Terminates the FeeCalc program.


 View Menu Commands

The default view consist of:

CPT/HCPCS Code (and modifier, if applicable)

CPT/HCPCS Description

Total RVU

Current Fee

Calculated Fee (RVU * calculated conversion factor)

Variance (Proposed Fee - Current Fee)

Notes

Open and closes the Notes column.

Detail

Open and closes the detailed data area consisting of:

Component RVU Columns (Work, Overhead, MalPractice)

 GPCI (Work, Overhead, MalPractice) for the selected locality (underneath the workspace)

Note that all columns (both displayed and hidden) may be opened/hidden/resized by grabbing the right edge of the column title area and moving the column width left or right.


 Edit Menu Commands

Copy

Copies the selected cells into the MS-Windows Clipboard.

Paste

Pastes the contents of the MS-Windows Clipboard to the selected cells.

CPT Info...

Opens the CPT Information Dialog of the currently selected record (row) for editing.

Table Info...

Opens the Table Information Dialog for editing.  (Only available if the program has been registered.)


 Main Screen

 Click the part of the FeeCalc Main Screen you want to know more about.

Cross-Reference

Table Dialog

 CPT Information Dialog

 User Supplied Conversion Factor

 Calculated Conversion Factor


 Table Dialog

 Click the part of the Table Information Dialog you want to know more about.

Cross-Reference

 GPCI Data

 User Supplied Conversion Factor

 Calculated Conversion Factor


 CPT Information Dialog

Click the part of the CPT Information Dialog you want to know more about.

Cross-Reference

 RVU Data


Physician Payment System
 Physician Payment Reform (PPR)

The term PPR is refers to the various provisions of the Omnibus Budget Reconciliation Act (OBRA) of 1989 and consist of 4 general components:

 	1.	Medicare payments for physician services are now based on a Resource Based Relative Value System (RBRVS)which defines a national Fee Schedule.  This Fee Schedule is based on and objective measure of the normal costs physicians incur in rendering a service instead of the subjective "customary/prevailing charge" of the old system.

 	2.	Medicare Volume Performance Standards (MVPSs) have been established to monitor annual increases in Medicare Part B payments and calculate future adjustments to these payments.

 	3.	Sweeping reforms to beneficiary financial protections.

 	4.	Medical policies and reimbursements were substantially standardized across Medicare carriers.

FeeCalc is based on the first major component - RBRVS.


RBRVS
 The Resource Based Relative Value Scale (RBRVS)

Although the government has long be an opponent of fixed pricing within the medical community, it has endorsed the concept of relative value pricing since 1985.  The development of the national RBRVS is but one of many such studies on the relative cost of medical procedures.  FeeCalc allows any Relative Value Study (RVS) to be used, but is tailored to the HCFA RBRVS.

Payments under the HCFA RBRVS Fee Schedule are based on 3 separate pieces of information:

 	1.	The Relative Value Units (RVUs) for each service (CPT).  These RVUs are established nationally and define the relative payment of every procedure code.

 	2.	The Geographic Practice Cost Indices (GPCIs) for the locality where the service was rendered.  GPCIs are established by each Medicare carrier to provide for minor adjustments to the nationally defined RVU.

 	3.	The national Conversion Factor (CF).  This is a single number which is recalculated annually to create a uniform adjustment to the Medicare Fee Schedule.

 	4.	Also, some Medicare schedule fee changes in 1992 (when RBRVS was adopted) were so far different from the pre-1991 fees that HCFA decided to implement a 5-year transition plan to move the schedule fee from the old (pre-1992) fee to the new fee.  This transition plan affects all CPTs where the pre-1992 fee is more than +/- 15% different from the new fee.  FeeCalc is capable of computing this 5-year transition amount if the Historical Payment Basis (HPB) is input.


Using RVU to Calculate Fees
 Using RVUs to Determine Procedure Pricing

The FeeCalc program was designed to calculate a recommend patient charge for a given procedure using either:

1.	A Calculated Conversion Factor; or

 	2.	A User Supplied Conversion Factor (possibly from a national or state RVU study).  Note that this mode is only available after the program has been registered.

In either mode, FeeCalc allows for input of all 3 components of RVU on a per procedure basis and the input of the 3 components of GPCI on a per practice basis.

In order that Unregistered Users may full analyze FeeCalc's capabilities, a session specific (temporary) registration is allowed from within the registration dialog.  Note that this registration will not become a

permanent part of the program without the registration password.

The User Supplied Conversion Factor switch is available on the Table Info Dialog (only available if the program has been registered).  If User Supplied Conversion factor has NOT been selected, FeeCalc will calculate a CF as the sum of all Current Fees divided by the sum of all Total RVUs:

 åCurrent Fees  /  åTotal RVUs.

After the Conversion Factor is calculated, a proposed fee and a variance are calculated for each CPT.  This "Proposed Fee" is calculated as Conversion Factor * Total RVU (this is the same for both a calculated Conversion Factor or a user supplied Conversion Factor).  The variance is the proposed fee minus the current fee.

Using this system, any available Relative Value study may be used to compute a set of proposed fees.

If RVUs are not available for all 3 components, the Total RVU for a procedure should be entered in the Work RVU field and the other 2 RVU fields should be set to '0'.


Common Acronyms
 Acronyms

 	CPT	Current Procedural Terminology

 	HCFA	Health Care Financing Administration

 	HCPCS	Health Care Procedure Coding System

 	HPB	Historical Payment Basis

 	GPCI	Geographic Practice Cost Indices (pronounced gypsie)

 	MVPS	Medical Volume Performance Standard

 	OBRA	Omnibus Budget Reconciliation Act, 1989

 	PPR	Physician Payment Reform

 	RBRVS	Resource Based Relative Value Scale

 	RVU	Relative Value Unit


The GPCI Schedule
 Geographic Practics Cost Indices (GPCI)

The Geographic Practice Cost Indices (GPCIs) are defined by each Medicare carrier to provide for minor adjustments to the national RVUs based on locality factors (i.e., variations in payments between large city and country environments).  The 3 components of GPCI parallel the RVU components of Work, Overhead, and MalPractice.  These components may be edited within the Table Info Dialog (only available if the program has been registered).  If this data is not available or is not being used for a given data set within FeeCalc, these fields should be set to '1'.


The RVU Schedule
 Relative Value Units (RVSs)

HCFA has defined 3 separate RVU components which affect the cost of a medical service, these are:

 	1.	Work - the direct cost of the provider's time and energies.

 	2.	Overhead - the indirect cost of providing the service, such as office staff, facilities, etc.

 	3.	MalPractice - the indirect cost associated with malpractice insurance for a given procedure (a relative measure of risk associated with a procedure).

Thes 3 RVU components are adjusted throughout the country by carrier defined GPCIs.  The GPCIs for each component are multiplied by the appropriate RVU to compute a total RVU:

 RVUTotal = (RVUWork * GPCIWork) + (RVUOH * GPCIOH) + (RVUMP * GPCIMP)

This total is then multiplied by a Conversion Factor (CF) to arrive at a procedure fee.  The components of RVU may be input for each procedure from the CPT Information Dialog (if the program has not been registered then only one RVU is available and represents a total RVU for the procedure).

Either way, the end results is a Fee based on the relative cost of the service being provided.


 Practice Name - This is the name of the practice and is input from the Program Registration Dialog.


 Participant Information - This denotes wheather the practice is a participant or non-participant.  This information is input from the Table Information Dialog (only available if the program has been registered).


 Conversion Factor - This denotes whether the current workspace is using the national conversion factor, or is dynamically calculating one. If National Conversion is selected, the Fee Schedule data may be input manually or calculated from the RVU/GPCI and Conversion Factor data.  This information is input from the Table Information Dialog (only available if the program has been registered).


 Base Date - This is the reference year for the CPT/HCPCS information being used.  This information is input from the Table Information Dialog (only available if the program has been registered).


 Carrier Information Area - This is the Medicare Carrier number and locality information for the GPCI data being used.  This area includes the Geographic Practice Cost Indicies.  This information is input from the Table Information Dialog (only available if the program has been registered).  Note that GPCI data is unavailable or not being used, all GPCIs should be set to 1.


 WorkSpace - This is the area where CPT/HCPCS information is created.  This information is input from the CPT Information Dialog.


 Table Size - This is the number of rows currently available within the CPT/HCPCS WorkSpace.  This limit is controled within the Table Information Dialog (only available if the program has been registered).


 Previous/Next Command Buttons - These buttons move the CPT Information Dialog up and down the WorkSpace.  Note that using these buttons automatically saves the data for the current record before moving to the previous/next record.


 Relative Value Unit - This is the nationally defined relative value units for each CPT/HCPCS broken down into its separate components.  Note that, if only 1 RVU is being used, the Work RVU should be used for the Total RVU, the other 2 RVUs should be set to 0.


Technical Support
 Registration and Technical Support

FeeCalc is a "shareware program" and is provided at no charge to the user for evaluation.  If you find this program useful and find that you are using FeeCalc and continue to use it after the end of the 30-day trial period, you must make a registration payment of $25.00 to Information Consulting.  The $25.00 registration fee will license FeeCalc for use by any one office.  This is basically a site license agreement.  Registrations may be mailed to:

 Information Consulting

115 Ridgeview Dr.

Athens, GA  30606-3857

Registered users are provided 30 days of free technical support.  This support is available by phone Monday through Friday, except national holidays, from 8:00am - 5:00pm Eastern Time.

 Voice:  706 548-0709

FAX:  706 548-5701

CompuServe:  72643,2626


ASP Ombudsman Statement
 Association of Shareware Professionals Ombudsman Statement

The author of FeeCalc, Terry Bond, is a member of the Association of Shareware Professionals (ASP).   ASP wants to make sure that the shareware principle works for you. If you are unable to resolve a shareware-related problem with an ASP member by contacting the member directly, ASP may be able to help. The ASP Ombudsman can help you resolve a dispute or problem with an ASP member, but does not provide technical support for members' products. Please write to the ASP Ombudsman at 545 Grover Road, Muskegon MI 49442 or send a Compuserve message to ASP Ombudsman 70007,3536.