CPT Code Impact Analysis

Learn how Performance Suite can help organizations better understand, prepare for, and develop a response plan to address the impact of upcoming Physician Fee Schedule (PFS) changes.

The Centers for Medicare & Medicaid Services (CMS) continues to adjust its PFS, which has material implications on professional services reimbursement and physician and APP compensation. It is critical that organizations using productivity-based plans understand the impact of these changes on reported physician and APP productivity levels, employed and independent physician compensation arrangements, and budgets. Performance Suite can help organizations better understand, prepare for, and develop a response plan to address the impact of upcoming PFS changes. Assessing current and proposed CPT code information provides leaders visibility into which physicians or groups are most directly impacted by a change in scale values.

Key Features & Benefits

  • Delivers comprehensive and disparate billing information in a central repository.
  • Analyzes the impact of multiple CMS scale values on physician and CPT code performance.
  • Automates modifier adjustments.
  • Integrates non-billable wRVU credit information for a holistic view of physician productivity performance.
  • Compares wRVU productivity performance to market-leading benchmarks and organization-defined budgets for provider and location.
  • Provides ongoing visibility to wRVU productivity performance using CPT code values for multiple CMS scales, which can help organizations:
    • Determine when to change scales.
    • Build trust with providers should the organization decide to adopt different scales.
  • Identifies providers/groups most directly impacted by changes in CPT code values due to updated CMS scales.
  • Measures the impact CMS scale changes will have on wRVU productivity related to compensation at an individual, group, and organizational level.

I used to spend hours each month visiting with 4 to 5 providers reviewing their patient schedules and validating wRVUs. I haven’t had a single request to sit down with anyone now that they have the insight and data they need.

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Value by Stakeholder

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  • Analyzes the impact of CPT code value changes on provider total wRVUs before adopting.
  • Auto-calculates providers’ current wRVU productivity on multiple CMS CPT code values.
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Physicians & APPs

  • Creates transparency into wRVU impact based on CPT code value changes.
  • Calculates accurate wRVUs due to consistent application of modifier adjustments.
  • Provides transparency into the impact of CPT code changes on productivity and performance, leading to increased provider trust and engagement.
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  • Measures impact and supports the adoption of new CMS scale CPT code values.
  • Provides insights into potential compensation adjustments for individuals or groups by identifying those with the highest impact.

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