I am having a very hard time figuring out a correct payment on a DME code based on a conversion factor and RBRVS. Here's what I have so far...

My contract is with a private insurance company for 175% of 2005 Medicare's RBRVS. The conversion factor the insurance company uses is 38.087. Since it is a DME code, I believe only the Non-Facility PE is used as there is no Work Value or Malpractice values. The Non Fac PE is 4.21. Our Medicare GPCI is 3.061.

Do I multiple 4.21, 3.061, and 38.087 together and then take 175% of THAT number?

I am sooo confused. I can code anything but believe in order to do my job correctly, also need to compute proper payment for each code. I just can't wrap my head around this one.

If there is anyone with experience in this... Please help me. I have tried over and over again.

THANK YOU, Jacqueline Kravitz, CPC