Proactively assessing the impact of CPT code changes on physician and APP compensation and productivity is critical

SullivanCotter CPT Solutions

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized its 2021 Physician Fee Schedule changes to the Evaluation & Management (E&M) codes, as well as other outpatient equivalent visit codes for OB and ESRD, and corresponding work RVU values to recognize increased work effort for office visits. These changes will have material implications on professional services reimbursement and physician and advanced practice provider (APP) compensation going forward.

The health care industry has not seen broad work RVU changes of this magnitude in well over a decade, so it will be critical for organizations using productivity-based plans to understand the impact of these changes on payor reimbursement, reported physician and APP productivity levels, employed and independent physician compensation arrangements and budgets, and to identify potential fair market value and commercial reasonableness implications.

Learn more about the changes to the 2021 Physician Fee Schedule >

Provider Performance Management Technology™

Provider Productivity Insights

• Analyze impact of changes to CPT codes and work RVUs against annual CMS scale conversion
• Load real-time data for ongoing review and analysis of work RVU productivity
• Work RVU and CPT code level productivity reporting capabilities at the organizational and individual physician or APP level
• Compare individual physician or APP work RVU productivity against any market-leading benchmarks survey

Benchmarks360™

Clinical CPT Manager

• Analyze and compare your organization’s CPT coding distribution at the specialty level against national physician and APP benchmarks including work RVU and CPT level volumes
• Visualize trends in annual coding profiles and benchmarking data
• Model impact of volume and full-time equivalent changes
• Leverage automation to remove data and reporting errors
• Customize views of coding details for clearer insights and custom analyses

SullivanCotter’s CPT Advisory Services

• Guidance on the changes and important considerations relative to 2021 planning and beyond
• Market insight and perspective on how other organizations are addressing the changes
• Assistance in assessing the anticipated impacts, including technology solutions available to help in that analysis
• Help understanding and identifying the potential implications of fee schedule changes on current fair market value standards and processes