Medicare Quarterly Update Instructions
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1 Medicare Quarterly Update Instructins Admin Screen RBRVS Prfile Under Admin Prfessinal Calc Engine Management, select RBRVS Prfile. Click Add t add a new RBRVS Prfile Fastlad the apprpriate file frm GPCI Prfile Under Admin Prfessinal Calc Engine Management, select GPCI Prfile Click Add t add a new GPCI Prfile Name Prfile Obtain the carrier and lcality fr the crrect state Medicare Medicare Fee Fr Service Payment Fee Schedules General Infrmatin Zip Cde t Carrier t Lcality File Carrier Cde is in Clumn C Lcality Cde is in Clumn D Obtain the GPCI Factrs fr the carrier/lcality fund in step ne Medicare -> Medicare Fee fr Service Payment ->Physician Fee Schedule -> PFS Relative Value Files -> Current Year and Quarter -> GPCIFY.xlsx (i.e. GPCI11 is fr 2011) Wrk GPCI is in Clumn G PE GPCI is in Clumn H MP GPCI is in Clumn I Frmat as Fllws in a new spreadsheet: Clumn A - Carrier Cde = 5 Digits Clumn B - Lcatin Cde = 2 Digits Clumn C - Wrk GPCI = Num(6,3) Clumn D - PE GPCI = Num(6,3) Clumn E - MP GPCI = Num(6,3) Nte the 6 represents 6 Characters befre the decimal Nte the 3 represents 3 Characters after the decimal Save as a csv. Fastlad file int GPCI Prfile *Nte: Make sure t add carrier/lcality cdes fr ALL states r lcatins that apply that may apply (i.e. hspitals n the barder f tw states; physician grups that span many states r zip cdes)
2 RBRVS Adjustment Prfile Under Admin Prfessinal Calc Engine Management, select RBRVS Adjustment Prfile This prfile shuld cme laded standard in every envirnment labeled as fllws Crrected Medicare RBRVS Adjustment Prfile If user needs t create a new prfile please fllw instructin in Prfessinal Medicare manual. Anesthesia Base Units Prfile Under Admin Prfessinal Calc Engine Management, select Anesthesia Base Unit Prfile Click Add t add a new Anesthesia Base Unit Prfile Name Prfile Enter 15 in bx next t Time Unit (in minutes) Select Rund t nearest tenth f a unit next t Runding Fastlad apprpriate file frm Anesthesia Cnversin Factr Prfile Under Admin Prfessinal Calc Engine Management, select Anesthesia Cnversin Factr Click Add t add a new Anesthesia Cnversin Factr Prfile Name Prfile Check CMS websitewww.cms.gvanesthesilgistcyxx Cnversin FactrOpen Excel Dcument Find apprpriate Lcality, nte the amunt listed under Natinal Anes CF Navigate back t Anesthesia Cnversin Factr Prfile within PIC Click add underneath the search sectin Input apprpriate Carrier and Lcality Cde Input apprpriate Cnversin factr *Nte: Make sure t add carrier/lcality cdes fr ALL states r lcatins that apply that may apply (i.e. hspitals n the barder f tw states; physician grups that span many states r zip cdes) *Nte: Carrier and Lcality cdes shuld match Carrier and Lcality cdes listed in the GPCI Prfile. Anesthesia Adjustment Under Admin Prfessinal Calc Engine Management, select Anesthesia Adjustment Prfile This prfile shuld cme laded standard in every envirnment labeled as fllws
3 Medicare Anesthesia Adjustment Prfile If user needs t create a new prfile please fllw instructin in Prfessinal Medicare manual. Prfessinal Fee Schedule Prfile Under AdminPrfessinal Calc Engine Management, select Prfessinal Fee Schedule Prfile Click Add t add a New Prfessinal Fee Schedule Prfile Name Prfile Dwnlad Fee Schedule Template frm Obtain the Clinical Lab Fee Schedule MedicareMedicare Fee fr Service Payment Clinical Lab Fee Schedule Fee Schedule Current File Obtain the DME/POS Fee Schedule Medicare Medicare Fee fr Service Payment Durable Medical Equipment, Prsthtics/Orthtics, and Supplies Fee Schedule DMEPOS Fee Schedule Current File Open up Fee Schedule Template Add Labratry Services Cpy the Clinical Lab Cdes and Mdifiers int Clumns B and C f the template Cpy the Clinical Lab Rates fr yur specific state int Clumn E f template Label these as Labratry Services: in clumn A f the template If previus rate schedules have anther Service Descriptin fr Labs please use instead f Labratry Services Add DME Services Cpy the DME Cdes and Mdifiers int Clumn B, C and D f the template Cpy the DME Rates fr yur specific state int Clumn E f template Label these as Durable medical Equipment in Clumn A f the template Insert tw (2) clumns between A and B Enter the Carrier Cde fr yur lcality in the new Clumn B Enter the Lcality cde fr yur lcality in the new Clumn C Insert ne (1) clumn between F and G Cpy clumn H int Clumn I Fr DME Cdes nly add Y in clumn J Frmat file as fllws Carrier Cde (Clumn B) = 5 digits Lcatin Cde (Clumn C) = 2 digits CPT4/HCPC (Clumn D) = 5 digits Rates (Clumns H and I) = number with 2 decimals
4 *Ntes: Services and matching rates will need t be added fr each carrier/lcality (i.e. the number f cdes and rates will be dubled if there are tw lcalities listed in yur GPCI Prfile) Delete the Header Rw and Save as a csv file. Fastlad file int Prfessinal Fee Schedule Prfile Save Prfessinal Terms Screen f Rate Schedule Once New rate schedule and terms have been created navigate t the Prfessinal Terms Tab f the rate schedule Medicare RBRVS Prfiles Find all newly created RBRVS Prfiles frm the steps listed abve RBRVS Prfile GPCI Prfile RBRVS Adjustment Prfile Budget Neutrality Factr remains at 1.00 Use Prfessinal Fee Schedule Rates Bx shuld be Unchecked Facility Reduced PE % Nn-Facility Reduced PE% Save Anesthesia Prfiles Find all newly created Anesthesia Prfiles frm the steps listed abve Anesthesia Base Rate Prfile Anesthesia Cnversin Factr Prfile
5 Anesthesia Adjustment Prfile Save Prfessinal Fee Schedule Rates Find newly created Prfessinal Fee Schedule Prfile frm steps listed abve Prfessinal Fee Schedule Prfile Save Rate Schedule Updates Fur Effective Perids/Rate Schedules Per Year January April July Octber Nte: These are the standard effective perids; yu may have additinal rate schedules based n updates t Facility Specific Factrs. Quarter: RBRVS Prfiles Anesthesia Base Units Prfile Anesthesia Cnversin Factr Prfessinal Fee Schedule January X X X X April X X July X X Octber X X Nte: This table is based n standard methdlgy; CMS may publish Transmittals which may require the updates abve t change.
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