This is my new book (co-authored with Owen Dahl) on applying the concepts of Lean Six Sigma to the medical practice. This book is specific to the practice and will allow you to:
This links to Frank Cohen's calendar that shows webinars, seminars, conferences, workshops and other programs in which he will be participating.
This .zip file contains an MS Excel file that detail the revised changes for the upcoming 16.0 release of the NCCI data set. The new data was released by CMS on 12/23/09 and includes an additional 951 active pairs and 262 terminated pairs.
This is a free-standing software program that reports individual RVUs and calculates adjusted and unadjusted totals as well as calculating the Medicare allowable. This program performs both a complete RBRVS analysis for the 2009 database as well as a practice- or physician-specific Medicare financial impact analysis by comparing RVU, conversion factor and Medicare frequencies for 2009 data to 2010 data. When you install the program, please take a moment to read through the Quick-Start guide. You can also access an on-line webinar that discusses the program and shows how to use the features by clicking here or by clicking on the Help menu option.
This is a MS Excel workbook that contains the average charge for all procedures in the CY 2008 P/SPS Master File (100% of Medicare claims) that were reported at least 5 times and had an associated total charges value. This workbook contains both average as well as variability statistics (mean and confidence interval).
This is a MS Excel workbook that contains the 2009 and 2010 RBRVS data for all procedure codes in the physician fee schedule database (PFSDB) that reported an RVU for both periods. All data are assosciated to the line-item procedure code and I have included variance calculations for your convenience.
This file contains the top 10 procedures reported to CMS for 70 different specialties. Data files are organized such that rank order is reported by frequency, charges and RVUs. This is a .zip file and the workbooks are in MS Excel.
This file contains a sample of the fee schedule workbooks now available from MIT Solutions, Inc. Each Microsoft Excel 2003 workbook deals with a single specialty and state. To simplify finding the information you need, the results are partitioned onto a set of worksheets:
Please feel free to contact us at support@mitsi.org with any questions.
These workbooks contain the same information as above only each workbook contains all specialties (one per tab) for a specific state for all states (one per tab) for all specialties. Please feel free to contact us at support@mitsi.org with any questions.
This Excel worksheet contains the minutes per work RVU data for many specialties and is used to calcualte the volume of work RVUs that would define 1 FTE based on the number of hours the pracices requres from a provider to be classified as 1 FTE. The instructions are on the main worksheet. I will also be conducting a brief (and free) webinar to go over the methodology, calculations and applications for this on Monday, July 6, 2009 at 3:00 pm EDT. For more info or to register, go to: https://www1.gotomeeting.com/register/734806513 or visit my website at www.frankcohen.com
This MS Excel worksheet contains the updated (July, 2009) national average charge for 9,680 procedure codes listed in the Physician Fee Schedule Database (PFSDB). For each procedure code, we show the mean charge calculated using a proporation distribution methodology; which is more accurate than either the arithmetic mean or median. We also show the standard deviation, the 95% confidence interval and the number of claim lines included in the calculation. The data is a compilation of all specialties in all geographic locations.If you are interested in seeing a demo of this, I will be showing it during my Building a Defensible and Profitable Fee Schedule webinar on Tuesday, July 7 at 3:00 EST. To register, click here or go to www.frankcohen.com and click on the Calendar tab.
This is a Windows-based free standing software program that is a very powerful and effective CCI look-up search engine. You can type in a column 1 code and get all associated column 2 codes, do the same in reverse, look up any two codes or create (by import or entry) your own custom list of codes. This is a 90-day trial version of the software and is designed to assist you in the transition of the304,000 new edit pairs effective April 1, 2009.
This is an analysis of utilization distribution changes of Office visit, Hospital visit, Consulting and Emergency department visit codes for 54 specialties between 2003 and 2004. This study uses a unique methodology in order to control for volume changes and changes to RVU values during this period. If you would like to view the document that accompanies the analysis, click here. It contains an introduction to the study, a statement of methodology as well as assistance in interpreting the results.
This is an excel file estimates the overall change in GPCI values by specific location. It is also an template
that, if you enter the percent distribution of procedure types performed by a practice (i.e., surgery, radiology,
pathology, E/M, etc.), will calculate the overall Medicare impact for the practice. It is based on the changes
in the GPCI components weighted by the proportion of work, practice expense and malpractice expense RVUs within
the entire database. To use it, go down the first few columns to find the specific locality for the practice. Then,
in the corresponding row, in columns W, X, Y, Z and AA, put the percent distribution of each code category reported
by the practice. When you are finished, Column AG will display the overall estimated adjustment for that practice.
Remember, this is estimated based on the weighted adjustment in the GPCI for that locality factored by the estimated
change in the allowable by category (based on the CF change and the removal of the BNA reduction factor) and doesn't
include any code-specific changes that may skew the data.
If you have any questions on this, please contact me by email
by clicking here.
This is a .Microsoft Excel spreadhsheet that contains RVU data for some 14,000 plus procedure codes found wthin the Physician Fee Schedule Database (PFSDB). It shows RVU values for CY 2008 and the proposed CY 2009 data set and provides comparisons between each of the components by procedure code. If you have any questions on this, please contact me by email by clicking here.
This is a .pdf file of an article written by Frank Cohen on Fee Schedule Analysis. This article was published in the October issue of The Journal of Medical Practice Management, posted here with permission of the publisher. Please do no redistribute this article to anyone else as it is posted here for individual use only.
This is a probe analysis that was conducted on eight medical practices to determine the affects of denials on practices after implementatin of EMR systems. The results show that denials due to medical necessity increased, likely due to an increase in the ease of documentation and level of procedure code compared to diagnoses codes.
This is an article co-authored by Frank Cohen, MPA and Mark Dietrich, CPA/ABV on conducting a coding analysis as part of the valuation process. This article was published in the Fall 2006 issue of the CPA Expert. This file is in Adobe .pdf format and requires Adobe reader to view.
The following links are directed to files that are part of Frank Cohen's seminar series for CY 2007. Each toolbox corresponds to a specific workshop and each is password protected. The password for extracting files was presented at the close of each associated workshop and is effective for both the toolboxes passed out on the CD at the workshop and the associated links to updated files below. You must have attended a workshop on the topic listed in order to have received the extraction password. If you did attend a workshop and have misplaced your password, please email to support@mitsi.org and give the date and title for the workshop you attended.
Comprehensive Error Rate Testing (CERT)
Conducting a Comprehensive Practice Assesssment
Building Effective Improvement Teams
A study was performed by a trio of researchers from the Department of Family Medicine, Northwestern University Medical School in Chicago, IL, comparing the E/M coding patterns of approximately 205 family physicians with that of a group of designated expert coders. They found that, for the most part, the sample physicians tended to over code on new office visits and under code on established office visits. This study used the information from the Northwestern study to quantify the financial impact such coding variances would have when applied to the Medicare database of all office visits by family physicians nationwide. This study used the CY 1999 Medicare claims database made available by CMS and the new and established office visits were extracted, filtered for appropriateness and the absolute utilization numbers calculated to develop a distribution model. The Medicare fee amount was weighted for distribution of facility and non-facility charges and relational models were established. The results indicated that it was the family physicians, not the payers, who suffered a financial burden. In this study, the physicians showed an overall under payment of approximately $50 million when extrapolated for the national family practice physician database published by Medicare. Further studies such as this are needed for more specialties in order to get a better picture on the impact such coding errors can have and should motivate physicians to seek out and invest in education and training for E/M coding to increase accuracy and assist them in optimizing their revenue through proper coding.
Summary
The Acuity Factor, whether used in total or broken down into its component parts, plays a useful role in the medical practice. As the payer side continues to move towards total business integration, applying these types of methodologies and techniques to determine fee schedule amounts and to design provider contracts, the medical practice must be able to respond in kind. And not only respond, but be proactive in their ability to accurately benchmark critical markers in their practice against external data sets. While the process may initially seem overwhelming, being able to produce efficient and usable reports from the practice management software can substantially reduce the resource overhead required to calculate the values necessary to conduct this type of study. In the absence of standardized and timely data, acuity factors provide for the practice a decision support model of sorts, contributing to the ability to monitor productivity, analyze for profitability and compliance, conduct meaningful comparative analyses and ensure parity with the payer side.