GEHA (Government Employee’s Hospital Association) Lee’s Summit, MO

“Case in Point” featured in Advance for Health Information Professionals®

RBRVS Fee Schedule Software Offers User-Friendly Solution

By Michael Dennison, Data Analyst

GEHA (Government Employee’s Hospital Association) Lee’s Summit, MO.

Reimbursing physicians at a level they find equitable while still making enough to meet expenses is a challenge all health insurance organizations face. Developing a system that creates physician fee schedules accurately, easily and quickly is an absolute necessity when working with thousands of physicians in many areas.

In 1998, the Government Employee’s Hospital Association (GEHA), based in Lee’s Summit, MO, decided to use the Health Care Financing Administration’s (HCFA) Resource Based Relative Value Scale (RBRVS) for its physician fee schedules in selected areas.

We had never used RBRVS before, as we developed proprietary fee schedules the previous year. Initially, using the RBRVS system was long and arduous because of the multiple tables used in the fee-schedule development. It was also very repetitive as we used the same process for each different area or physician group, but only a couple components changed each time. Eventually we created a database application coded in Visual Basic for Applications to shorten the process. This system was somewhat flexible, but not very user-friendly or easy to use.

In late 1998, we started looking for easier alternatives to creating physician fee schedules. We needed a program that was accurate, flexible and easy to use. We chose RBRVS EZ-Fees, an economical and user-friendly software package from Wasserman Medical Publishers. We are currently incorporating RBRVS EZ-Fees into an expanded system that will not only create physician fee schedules, but also will allow basic user-level analysis of the fee schedules.

Currently, our system of fee schedule analysis starts with the network development department, which generates a fee schedule from our database application based on the percentages they desire. The database application creates a text file, which the data analysis department then transfers to the mainframe and generates a comparison report using FOCUS. This comparison report compares the proposed fees to various benchmarks, which gives us a basic analysis including what kind of discount that fee schedule will give GEHA. Depending on workload, this whole process could take a day or longer.

To shorten this time, we recently decided to transition all basic-level fee schedule analysis to the network development department, including comparison report generation. RBRVS EZ-Fees will help us achieve that objective several ways.

By using RBRVS EZ-Fees, we can transition the network development department with minimal training. “Right out of the box,” RBRVS EZ-Fees is easy to use and the buttons/controls are logically organized and self-explanatory. With just a couple of mouse clicks, we can create a Medicare fee schedule for any area we need. With just a few more clicks, we can customize that schedule to any percentage or conversion factor. The big advantage RBRVS EZ-Fees has over our in-house database is that it allows us to adjust any number of fees in any number of different code ranges.

Another very important feature to us is the import/export capability. To analyze the fee schedule against the benchmarks, we can export the fee schedules we created in RBRVS EZ-Fees to several formats. The most helpful formats for us are the comma-separated value and the Microsoft Excel formats. We can import the Excel file into a spreadsheet template, import the benchmarks, and we complete a comparison report. If we need to “tweak” individual codes or ranges of codes, we can import the Excel file back into RBRVS EZ-Fees after making minor modifications to the spreadsheet.

Finally, RBRVS EZ-Fees was very economical. We paid only $199 per copy for a program that looks better and runs better than the application that took us weeks to create. The economical price allows us to give multiple users the ability to create and analyze fee schedules inexpensively.

Two other points impressed us about RBRVS EZ-Fees. The first is the program was on CD, which made for easier installation. The second is when we had questions concerning certain features. The technical staff was friendly, courteous and very knowledgeable about the program. Best of all, the answers were free.

Once we finish implementation, RBRVS EZ-Fees will give us the capability to generate the physician fee schedules we need quickly, easily and inexpensively. This will, in turn, allow faster analysis by the people who need the information and will allow other personnel to focus on other projects.