What is PFSS?
Physician's Fee Schedule Software ("PFSS") is the software professionals
use to create physician compensation systems that include:
- RBRVS-based fee schedules for physician services performed in their offices or in hospitals and other facilities;
- Fee schedules for lab tests, supplies, drugs, and services in the HCPCS system.
- PFSS Version 14.0 for 2013 consists of eleven Microsoft Excel files:
Physician's Fee Schedule Software ("PFSS") is perfect for physicians, hospitals, clinics, managed care HMOs, PPOs, IPAs, and TPAs, health plans, accounting, actuary, billing firms, health care reimbursement experts, and anyone else who uses the RBRVS to manage medical reimbursement.
- ANESTHESIA - Fee schedule for anesthesia services. Unlike medical and surgical procedures, anesthesia does not use GPCIs. Instead, different localities use different conversion factors, a list of which is provided in the Manual.
- CLINICAL LAB - Fee Schedule for clinical lab procedures based on 2013 National Limits established by Medicare. Users can un-hide columns that include numbers for their locality or use the National Limit column. Alternatively, one can ignore this file and use the clinical lab RVUs established by RVSI in the FACILITY and OFFICE files.
- CMS Database 2013 - This is the complete CMS relative value unit database for 2013. It is included so you can create custom files.
- DME AND SUPPLIES - Fee Schedule for pricing of HCPCS denominated supplies and services based on CMS 2013 fee schedule: prosthetics, orthotics, and supplies; parenteral and enteral nutrition items and services.
- DRUGS AND VACCINES - This file is based on the CMS files for drugs called the ASP files (average sales price) published on the CMS website, effective January 1, 2013.
- FACILITY - Fee Schedule file for Facility pricing. In this file are procedures performed by physicians in non-office settings such as hospitals, outpatient surgery center, and nursing homes.
- HEADER TEMPLATE - This header is supplied to assist you with creating custom spreadsheets. It contains the formulas that are present in the OFFICE and FACILITY files.
- OFFICE - Fee Schedule for Non-Facility pricing. In this file are procedures performed by physicians in medical offices.
- RADIOLOGY CAPS - This file contains the capped payment amounts for the technical component and the global fee for diagnostic imaging procedures as published on the CMS website, effective January 1, 2013.
- RVSI 2013 DATABASE - This is the complete Relative Value Studies, Inc. ("RVSI") relative value unit database for 2012. It contains RVUs for approximately 950 more procedures than the Medicare one. Like the former, it is included so you can create custom files.
- SURGERY - CPT® codes, nomenclature, professional and technical component indicators, global days, pre-op, intra-op percentages, multiple procedure rules, bilateral surgery rules, assistant and co-surgeons, team surgery, and endoscopic base codes.
Version 14.0 also includes a manual that covers the following topics:
- Computer and Software Specifications
- An explanation of the Resource Based Relative Value System
- File Contents, a description of the following files:
- Clinical Lab
- CMS Database 2013
- DME and Supplies
- Drugs and Vaccines
- Header Template
- Radiology Caps
- RVSI Database 2013
- Elements of a Fee Schedule
- Column Definitions
- Hidden Columns
- More Column Definitions
- Conversion Factors for medical and surgical procedures and for anesthesia, for every locality in the United States
- GPCIs: geographic price cost indices for every locality in the United States
- Using PFSS:
- Data Entry Points
- Creating Fee Schedules
- Changing Nomenclature
- Changing RVUs
- Creating Customized Files
- Saving Files
- Conversion to Other Formats
- Medicare's Charge Rules
- Welcome to the PFSS Users' Forum
The following are the minimum tested specifications you need to run PFSS:
- PC or 100% compatible Pentium class computer
- 32 Megabytes of Random Access Memory (RAM)
- 15 MB of free hard disk space
- CD-ROM drive
- Color Monitor
- Microsoft Windows 98 or greater
- Microsoft Excel 1997 or newer for Windows or compatable spreadsheet software such as OpenOffice or Lotus Notes