aaron.lucas
Expert
Hello all,
Ok, question for anyone who can answer, but first some backstory: I work in NJ for a 3rd party vendor that does admin work for Auto Insurance. We review medical bills related to PIP claims. NJ DOBI (Dept of Banking and Insurance) just released a new Fee Schedule. The fee schedule rule states that any service not on the fee schedule should be paid based on the fee for a similar procedure (or in the case of no similar procedure, by UCR).
Now here is the big issue: The new NCV codes are not in the fee schedule, so according to the regs we have to crosswalk to the old codes. The problem is the old codes all had different fees, and we dont know what combinations these could be billed in to make up a "bundled" fee for these new codes. Basically to figure out the fee for a new code we would need to, on a case by case basis, review and find out what types of studies were done, and then try to add it all up. This could be done, but should we count motors as with or without F-wave, since the new codes dont really take it into account?
Does anybody know, or is anybody familiar with how CMS did their crosswalking of RVUs? Anybody know their methodology? How did others figure this out? I'm struggling to come up with an idea for management and could use some advice. Also if anybody has figured out how to automatically calculate a crosswalked fee based on a programmable formula that would be helpful too! I know this is a lot but any help would be greatly appreciated!
Thanks!
PS I also posted this in Billing/Reimbursement but figured I'd try in two places, just in case.
Ok, question for anyone who can answer, but first some backstory: I work in NJ for a 3rd party vendor that does admin work for Auto Insurance. We review medical bills related to PIP claims. NJ DOBI (Dept of Banking and Insurance) just released a new Fee Schedule. The fee schedule rule states that any service not on the fee schedule should be paid based on the fee for a similar procedure (or in the case of no similar procedure, by UCR).
Now here is the big issue: The new NCV codes are not in the fee schedule, so according to the regs we have to crosswalk to the old codes. The problem is the old codes all had different fees, and we dont know what combinations these could be billed in to make up a "bundled" fee for these new codes. Basically to figure out the fee for a new code we would need to, on a case by case basis, review and find out what types of studies were done, and then try to add it all up. This could be done, but should we count motors as with or without F-wave, since the new codes dont really take it into account?
Does anybody know, or is anybody familiar with how CMS did their crosswalking of RVUs? Anybody know their methodology? How did others figure this out? I'm struggling to come up with an idea for management and could use some advice. Also if anybody has figured out how to automatically calculate a crosswalked fee based on a programmable formula that would be helpful too! I know this is a lot but any help would be greatly appreciated!
Thanks!
PS I also posted this in Billing/Reimbursement but figured I'd try in two places, just in case.