Click on the screen shot above for a tour
and table details .
1998, RBRVS EZ-Fees has helped thousands of health care professionals simplify
the Medicare payment formula. With a few clicks you can create
medical fee schedules without
government downloads or
complicated formulas. Most users have mastered
our software in 5 minutes!
customers include: physicians and other
providers, office managers, insurance
companies and other providers (HMO, PPO,
TPA, PHO, IPA), CFOs, CEOs,
CPAs, consultants, state and federal
agencies, medical societies, associations,
payers, billing services, accountants,
actuaries, lawyers, life care planners
and other healthcare professionals.
comes with all *CPT / HCPCS codes,
descriptions, unit values, GPCIs,
conversion factor (CF) preloaded. *A licensed AMA CPT product.
100% Money Back Guarantee
shipped with 24 hours of prepayment
EZ-Fees is a low cost, easy-to-use
(Windows) software program that creates
and analyzes physician payments using
Medicare's RBRVS (Resource Based
Relative Value Scale).
All US localities included.
is not just for Medicare.
to the AMA, RBRVS is widely used in non
Medicare medical reimbursement including
managed care and private insurance.
Most states' worker compensation boards
have adopted RBRVS as their payment
model due to its universal acceptance.
CMS (coding and fee updates are
FREE with RBRVS EZ-Fees for the Fiscal
Year. Visit our update
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can export fees, unit values, codes,
descriptions and notes for over 10,000
CPT/HCPCS codes to Excel, ASCII, Lotus
or dBASE or print custom reports.
includes 5 user defined fee and
per session. Allows for unlimited
EZ-Fees is so easy-to-use there is only
one main screen and no technical manual!
(free technical support if needed)
be fooled by our low price ($199) -
RBRVS EZ-Fees has all the features plus
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software packages costing hundreds more.
2013 President Obama Signs the American
Taxpayer Relief Act of 2012
Law Includes Physician Update Fix through December
Wednesday, January 2, 2013, President Obama signed into
law the American
Taxpayer Relief Act of 2012.
This new law prevents a scheduled payment cut for
physicians and other practitioners who treat Medicare
patients from taking effect on January 1, 2013.
The new law provides for a zero percent update for such
services through December 31, 2013. This provision
guarantees seniors have continued access to their
doctors by fixing the Sustainable Growth Rate (SGR)
through the end of 2013. President
Obama remains committed to a permanent solution to
eliminating the SGR reductions that result from the
existing statutory methodology. The Administration
will continue to work with Congress to achieve this
new law extends several provisions of the Middle
Class Tax Relief and Job Creation Act of 2012 (Job
Creation Act) as well as provisions of the Affordable
Care Act. Specifically, the following
Medicare fee-for-service policies (with January 1, 2013,
or October 1, 2012, effective dates) have been extended.
CMS has provided Medicare billing and claims processing
information associated with the new legislation.
Please note that these provisions do not reflect all of
the Medicare provisions in the new law, and more
information about other provisions will be forthcoming.
601 – Medicare Physician Payment Update
– As indicated above, the new law provides for a zero
percent update for claims with dates of service on or
after January 1, 2013, through December 31, 2013.
The Centers for Medicare & Medicaid Services (CMS)
is currently revising the 2013 Medicare Physician Fee
Schedule (MPFS) to reflect the new law’s
requirements as well as technical corrections identified
since publication of the final rule in November.
For your information, the 2013 conversion factor is
order to allow sufficient time to develop, test, and
implement the revised MPFS, Medicare claims
administration contractors may hold MPFS claims with
January 2013 dates of service for up to 10 business days
(i.e., through January 15, 2013). We expect these
claims to be released into processing no later than
January 16, 2013. The claim hold should have
minimal impact on physician/practitioner cash flow
because, under current law, clean electronic claims are
not paid sooner than 14 calendar days (29 for paper
claims) after the date of receipt. Claims with
dates of service prior to January 1, 2013, are
unaffected. Medicare claims administration
contractors will be posting the MPFS payment rates on
their websites no later than January 23, 2013.
2013 Annual Participation Enrollment Program allowed
eligible physicians, practitioners, and suppliers an
opportunity to change their participation status by
December 31, 2012. Given the new legislation, CMS
is extending the 2013 annual participation enrollment
period through February 15, 2013. Therefore,
participation elections and withdrawals must be
post-marked on and before February 15, 2013. The
effective date for any participation status changes
elected by providers during the extension remains
January 1, 2013.
602 - Extension of Medicare Physician Work Geographic
Adjustment Floor -
2012 1.0 floor on the physician work geographic practice
cost index is extended through December 31, 2013.
As with the physician payment update, this extension
will be reflected in the revised 2013 MPFS.
603 - Extension Related to Payments for Medicare
Outpatient Therapy Services
603 extends the exceptions process for outpatient
therapy caps through December 31, 2013. Providers
of outpatient therapy services are required to submit
the KX modifier on their therapy claims, when an
exception to the cap is requested for medically
necessary services furnished through December 31, 2013.
In addition, the new law extends the application of the
cap and threshold to therapy services furnished in a
hospital outpatient department (OPD), and counts
outpatient therapy services furnished in a Critical
Access Hospital towards the cap and threshold.
Additional information about the exception process for
therapy services may be found in the Medicare Claims
Processing Manual, Pub.100-04, Chapter 5, Section 10.3:
therapy caps are determined for a beneficiary on a
calendar year basis, so all beneficiaries began a new
cap for outpatient therapy services received on January
1, 2013. For physical therapy and speech language
pathology services combined, the 2013 limit for a
beneficiary on incurred expenses is $1,900. There
is a separate cap for occupational therapy services
which is $1,900 for 2013. Deductible and
coinsurance amounts applied to therapy services count
toward the amount accrued before a cap is reached, and
also apply for services above the cap where the KX
modifier is used.
603 also extends the mandate that Medicare perform
manual medical review of therapy services furnished
January 1, 2013 through December 31, 2013, for which an
exception was requested when the beneficiary has reached
a dollar aggregate threshold amount of $3,700 for
therapy services, including OPD therapy services, for a
year. There are two separate $3,700 aggregate
annual thresholds: (1) physical therapy and
speech-language pathology services, and (2) occupational
604 - Extension of Ambulance Add-On Payments
604 extends the following three Job
Creation Act ambulance payment provisions:
(1) the 3 percent increase in the ambulance fee schedule
amounts for covered ground ambulance transports that
originate in rural areas and the 2 percent increase for
covered ground ambulance transports that originate in
urban areas is extended through December 31, 2013; (2)
the provision relating to air ambulance services that
continues to treat as rural any area that was designated
as rural on December 31, 2006, for purposes of payment
under the ambulance fee schedule, is extended through
June 30, 2013; and (3) the provision relating to payment
for ground ambulance services that increases the base
rate for transports originating in an area that is
within the lowest 25th percentile of all rural areas
arrayed by population density (known as the “super
rural” bonus) is extended through December 31, 2013.
is currently revising the 2013 Medicare Ambulance Fee
Schedule (MAFS) to reflect the new law’s
requirements. In order to allow sufficient time to
develop, test, and implement the revised MAFS, Medicare
claims administration contractors may hold MAFS claims
with January 2013 dates of service for up to 10 business
days (i.e., through January 15, 2013). We expect
these claims to be released into processing no later
than January 16, 2013. The claim hold should have
minimal impact on supplier cash flow because, under
current law, clean electronic claims are not paid sooner
than 14 calendar days (29 for paper claims) after the
date of receipt. Claims with dates of service
prior to January 1, 2013, are unaffected.
of ambulance services affected by these provisions may
continue billing as usual.
605 - Extension of Medicare Inpatient Hospital Payment
Adjustment for Low-Volume Hospitals
Care Act allowed qualifying low-volume
hospitals to receive add-on payments based on the number
of Medicare discharges. To qualify, the hospital
must have less than 1,600 Medicare discharges and be 15
miles or greater from the nearest like hospital.
This provision extends the payment adjustment through
September 30, 2013, retroactive to October 1, 2012.
Be on the alert for further information about
implementation of this provision.
606 - Extension of the Medicare-Dependent Hospital (MDH)
MDH program provides enhanced payment to support small
rural hospitals for which Medicare patients make up a
significant percentage of inpatient days or discharges.
This provision extends the MDH program until
October 1, 2013, and is retroactive to October 1, 2012.
Be on the alert for further information about
implementation of this provision.
Does the 2% payment reduction under sequestration
apply to the payment rates reflected in Medicare
fee-for-service fee schedules or does it only apply to
the final payment amounts?
Payment adjustments required under sequestration are
applied to all claims after determining the Medicare
payment including application of the current fee
schedule, coinsurance, any applicable deductible, and
any applicable Medicare Secondary Payment adjustments.
All fee schedules, Pricers, etc., are unchanged by
sequestration; it’s only the final payment amount
that is reduced. Medicare
Advantage Plan’s Fees and payment arrangements
are contractually negotiated with
their Plan network
not subject to this policy. Medicare’s monthly
case-mix adjusted payments to the Plans are subject to
a -2% reduction.
Update - Any Medicare's Advantage Plan payments to plan-non-participating providers Medicare would be subject to the -2% reduction as long as they participate in traditional Part B Medicare