The Health Care Industry's Standard Formula
The Harvard School of Public Health helped create formulas that take into
account the cost of delivering each procedure, including doctor work, overhead,
staff, equipment, administration, and risk. This system of formulas is called
the Resource Based Relative Value Scale (RBRVS).
The formulas used in "AccuFee" are the same as those used by Medicare, state health programs, and major insurance companies. The RBRVS has become the health care industry standard in creating fees and payments. It is important that optometrists use these formulas to stay economically viable.
CMS (Centers for Medicare and Medicaid Services) updates the formulas every year to reflect changes in health care and business costs.
A new Edition of "AccuFee" is available each mid-December. It contains CMS's new year formulas to update your fee schedule, and has expanded formulas in the "3rd Party Payment Calculator" to accurately predict 3rd party payment.
CPT Codes Updated Annually
As you know, the CPT (Current Procedural Terminology) codes are revised yearly. Each new year version of "AccuFee" contains the most current version of CPT, reflecting new codes, changed codes, and deleted codes. Your office has the essential CPT updated codes without having to reference the new year’s CPT manual.
Office Fees Calculator
“Office Fees Calculator” is a worksheet which will calculate your office fees. This page calculates office fees using a very accurate system to guarantee you never leave any money on the insurance reimbursement table. For each of the 321 procedures, AccuFee searches 6 years of RBRVS to find the highest value, and uses the “high-water” value to calculate office fees.
Why? Because many non-Medicare insurances use past year’s RBRVS formulas, which for many procedures pay higher than this year’s values. If a doctor uses only the current year RBRVS to create office fees, he will leave money on the insurance table from those companies that use older, higher paying formulas.
Your fees will now be fair, reasonable, in proportion, defendable, and accurate. This is because your fees will be based on the same formulas that government and insurances use to calculate your payments.
Update Your Office Fees Annually
Update your office fee schedule at least once a year (January 1) to remain current with 3rd party payments. For example, Medicare changes its payment schedule every January 1. State agencies and other plans often change their payment schedule July 1. With "AccuFee" your office can remain current with Medicare payments starting the first day of the year, every year.
Under certain circumstances, a service is partially reduced at the physician's discretion. There is a column in "Office Fee Calculator" for calculation of reduced services.
The Reduced Services column might also be used for calculation of discount for payment at time of service, if desired.
Accurate Fees for Your Office Location
CMS formulas differ state to state, so this program is designed separately for each state, and specifically for your economic region to ensure accurate fees.