Before Using Revolution Software, It Is Important to Have Your Data Ready to Load

Getting Started with HealthcentsRevolutiontm Software

Before using Revolution Software, it is important to have your data ready to load. The following two files are needed to load the tool, a charge master file and a payer data file. These files are attached to the web URL www.healthcents.com/html/kickoff.html

Please use the attached Payer Allowable sample files and make additional copies of each of these sample payer data file, as needed, one for each payer. Samples are included. You need only one charge master file completed per practice or ASC. You also need a completed payer file for each payer that you plan to analyze. The attached charge master should contain ALL codes that are in all payer analysis files. A payer file may not contain any codes that are not in the chargemaster. Also, there must be no 0 values in either the volume field, billed charges or payer allowable fields. In other words, the codes in the charge master must be the same or a super set of the payer files. That is, codes contained in each payer file must be in the charge master. A specific payer file may have less codes than are in a chargemaster or exactly the same codes. If possible, for consistency of analysis and benchmarks, it is recommended that you use the same codes in the chargemaster and the payer files, if possible.

Please use the attached format for the chargemaster file and for the payer file(s). For instance, use O for Office, do not spell out office etc.In the chargemaster file, please list each code, the billed charges, and O or F, for the location where the service is performed. O for office and F if the code is performed mostly in a hospital or ASC. Please follow the same approach for payer data except that you will need in to specify the volumes by code and the maximum payer allowable at 100% including copayment from that payer. The only difference between the physician files and ASC files is that ASC files DO NOT require the O or F. To build an ASC file, simply delete the column in the sample file that specifies O or F and save. For physician practices, remember to specify the site of service and to be consistent with the codes listed in the chargemaster. If you do not have payer allowables, then simply average your last 5-6 claims, at 100% including co-payment, and use that value as the payer rate rather than the allowable or contracted rate. Make sure that the allowable / payer rate is for primary procedures / global codes only, not 026 or TC specific codes. RevolutionSoftware recently added a feature to allow support, not only for global modifiers, but, TC and 026 Codes, where applicable, i.e., radiology. If you would like to include global modifiers, just fill out columns A-C of the chargemaster, and A-D of the payer allowable files, as illustrated in the sample files. If you would like to add code(s) which support Technical and Professional Services Components, the use column D of the charge master and column E of the payer allowable files to specify TC or 026 in these columns. As with global modifiers, a code for a TC or 026 service must exist in the chargemaster to be used in one or more payer files.

It is recommended that you use the top codes that represent at least 80% of your practice’s revenue / book of business. In our experience, this is typically your top 15-40 CPT codes. Ultimately, the chargemaster should be a compilation of your top codes based on revenue by code. Currently, the RevolutionSoftware web service supports all current year CMS / CPT surgical codes but does not support lab codes, DME, O and P, and drugs and medications (e.g., J, G, I codes etc). Also, the tool is designed for PPO and HMO Point of Service Contracts Analysis Only. Please enter only PPO and HMO fee for service agreements into this tool, not capitated agreements or bonus plans. In the physician charge master files, one only for your practice or ASC, you need to have the CPT code in column A, your practice’s billed charge for this procedure in column B and where the procedure is performed in column C by specifying O for in the office and F for in a facility (Hospital or ASC). Billed charges and payer allowables are at 100% including co-payments. MAKE SURE TO SAVE THIS FILE AS CSV, NOT XLS, in your spreadsheet program. In the attached sample payer csv files you complete for each of your payers (Copy the file and you will need one payer CSV file for each payer that you plan to analyze),please list the CPT codes in column A, the volume or frequency performed per year for that code in column B, payer allowable amount in column C, and O or an F in column D. Please note that it is VERY important that this data be filled in exactly as indicated in the sample files. For example, do not put Office in place of O, do not rearrange the columns and do not add any columns. Some clients have supplied more information than is requested. These data files are input exactly in the format specified into the HealthcentsRevolutionweb service tool and if you make changes to the format, even slight revisions, the data loading will not work. Simply add as many rows as you like, for each code. We recommend focusing on your top codes based on revenue. Please follow the precise format of these files and simply add a row for each surgical code. Also, you do not need to edit the text in rows one and two of your charge master and payer analysis files.

In the meantime, if you would like to review a presentation and demonstration of the RevolutionSoftware Web Service, it is available at: http://healthcents.com/presentation-demo-reports/

Thank you for purchasing RevolutionSoftware and we look forward to working with you as a valued client.