WHAT IS THE RMS PROCESS FOR MODEL DEVELOPMENT?
The process for developing our model starts by identifying:
- CPT Appropriate CPT/HCPCS Codes to report your device/procedure.
- CPT CPT/HCPCS Codes that are ancillary to your device/procedure (downstream revenue).
- Financial projections by sites of service for your device/procedure (inpatient, outpatient, ASC, physician office,and DME).
- Current Medicare and Private Payer reimbursement rates for your device/procedure (by site of service).
- Coding Convention (CCI edits, multiple procedure rules, bundling of services) that applies to your device/procedure.
- Payer coverage policy for your device/procedure and apply payment filters to compensate for coverage or non-coverage decisions by specific payers.