BC Advantage - 2010 Issue 8
Developing a Relative Value-Based Fee Schedule
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Article Overview
This article covers the use of the resource-based relative value scale in physician fee schedule development, with emphasis on Medicare payment methodology, RVU-based analysis, geographic adjustment concepts, and practical fee schedule benchmarking. It is relevant to coders, practice managers, billing staff, and anyone involved in physician fee setting, contract analysis, or reimbursement planning. The discussion is framed around how fee schedules can be organized, evaluated, and updated using relative value and Medicare-oriented data.
Why This Topic Matters
Understanding relative value-based fee schedules helps practices create pricing structures that are easier to analyze, compare, and maintain over time. The article also provides context for how Medicare-based benchmarks and geographic adjustment concepts influence payment methodology and fee schedule strategy.
Article Sections
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Resource-Based Relative Value Scale and Fee Schedule Basics
Introduces the relative value framework used in physician payment methodology and explains its role in fee schedule development. Covers the overall structure of relative value-based pricing and annual updates.
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Building a Relative Value-Based Fee Schedule
Describes the practical steps used to assemble and compare fee schedule data. Focuses on spreadsheet setup, relative value analysis, and benchmark comparison using Medicare-oriented information.
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Medicare Conversion Factor and Payment Methodology
Explains the conversion factor concept and its relationship to payment calculations. Discusses how Medicare-based conversion analysis is used to translate relative values into fee schedule strategy.
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Geographic Practice Cost Indexes and Medicare Payment Components
Summarizes the geographic adjustment framework and the major components involved in Medicare payment calculation. Includes the broader structure of payment locality adjustments and related relative value elements.
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Applying Conversion Factors
Introduces the next topic in the series involving different ways to apply conversion factors. Provides a transition to fee schedule refinement and conversion-factor comparison.
What You Will Learn
- How relative value-based fee schedules are organized at a high level
- Why Medicare physician fee schedule concepts are used in fee analysis
- How conversion-factor analysis supports fee schedule benchmarking
- What broad components contribute to geographic payment adjustments
- How relative value data can be used to evaluate and update practice fees
Who Should Read This
- Medical coders
- Practice managers
- Billing staff
- Physician office administrators
- Reimbursement analysts
- Contracting and managed care personnel
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