Data Warehouse User Group January 21, 2004 I. Utilization Cube II. RVU Calculations III. PSA Matching

Utilization Cube This cube is geared towards productivity analysis. When analysis is done using the Post Period the information will balance to the IDX Service Analysis report. It is based on charges. No payment information is included.

Additional Elements In Utilization Cube Service Provider Nurse Practioners Psychologists Relative Value Units (RVU) Work Total Procedure and Diagnosis Codes

Key Uses Utilization by Provider (Chgs. Or RVUs) Top 25 Procedures or Diags Trending Production by Month/Qtr RVU analysis Coding Analysis by Provider (E&M)

RVU Methodology - Background Since 1992, the federal government has been using the uniform relative value scale. Each CPT code has a numeric value assigned to it for physician work, practice expense, and malpractice.

RVU Methodology - Background Some Modifiers affect reimbursement Modifier 62 – Two Surgeons = 62.5% Modifier 80 – Assistant Surgeon = 16% The GPCI takes into account geographic differences in wages, malpractice, etc.

RVU Methodology - Background CMS defines “Pro” and “Tech” components of codes for Professional fees and Technical Expenses. (Mods 26 and “TC”) Because of the routing of charges to IDX and SMS, UCSF uses prefixes to designate pro and tech components. Prefix 3 = Pro = Work + Malpractice Prefix 7 = Tech = Practice Expense Prefix 2 or no prefix = global

RVU Methodology - DWH Method Steps used to adjust DWH RVUs: GPCI adjust the current Medicare Schedule. For each charge, pull in the appropriate base value (including those with Mods 26 or “TC”). Reduce the values for approved modifiers or prefixes based on the UCSF schedule. Multiply by number of units. (Please refer to handout for additional detail)

Matching to PSA Report The Professional Service Agreement (PSA) defines the flow of funds to the department. PSA departments are defined as a collection of cost centers and exist in the Accounting department. They are not easy to extract from IDX.

PSA Report - Structure Charges and Revenues are broken out by billing agent. MGBS Per-Se “Cash Receipts” is actually “Net Revenue”.

PSA Matching - Steps Pull in the Post Month as columns. Add PSA Department as a row. Add Charges & Payments to row. Add Refunds/CR Adj/DB Adj from Measures. Add “787” as short drop to CR Adj. Add “611, 687, 90” as short drop to DB Adj. Add Group/Prov as a long drop.

PSA – Revenue Adjustments Start with Cash Receipts. Less Refunds Add Refund Reversal (787) Less Check Returned (611) Less Credit Balance Adj. (687) * Less Escheat (90) * Grand Total = Net Revenue * Included in Other Operating Revenue