Sample Schedule, Answers to Most-Asked Questions Now Available for Harvard Pilgrim’s RBRVS Fees

With Harvard Pilgrim Health Care poised to update its physician fee schedule April 1, the plan is making sample schedules available to contracted providers on request.

Providers will be required to sign a confidentiality pledge prior to receiving a sample fee schedule.

As reported in the February issue of Vital Signs, Harvard Pilgrim’s updated fee schedules will use industry standard methodologies, based on the Medicare Resource Based Relative Value Scale (RBRVS), and will include a site-of-service differential.

Sample fee schedules can be requested by contacting Harvard Pilgrim Health Care’s Provider Relations Department at (866) 884-3845 or (617) 509-0204.

Questions Answered
Harvard Pilgrim has provided these answers to questions most often posed by physicians:

Q Are all services covered under this RBRVS system?

A Relative Value Units (RVUs) apply to most physician services. Certain categories, such as lab services and injectable drugs, are not included in the RVUs. Fees for these services will be based on Medicare reimbursement or other industry standards.

Q Why is the new fee schedule not effective until April 1?

A Medicare issues new RVUs every year late in the fall. Once the new RVUs are issued, Harvard Pilgrim needs time to review the RVUs and update the fee schedule. By implementing the new fee schedule on April 1, Harvard Pilgrim can use the most current RVUs issued by Medicare for 2002.

Q What Is a Site-of-Service Differential?

A Sometimes physicians perform services in a hospital setting that could also have been performed in the office. Because the physician’s overhead cost is increased when service is provided in the office, Harvard Pilgrim will reimburse a physician more for certain services provided in an office rather than in a hospital.

HPHC to Attend MMS Meeting
Harvard Pilgrim representatives have been invited to attend a joint meeting of the Interspecialty Committee and Committee on Managed Care in March to provide information about the decision, transition, and impacts of the conversion to RBRVS.

The MMS Department of Health Policy and Systems will continue to monitor and educate physicians regarding the implementation process. If you have questions or concerns, please contact Dana Holmes, manager, Health Systems, at (781) 434-7218 (dholmes@mms.org) or Elaine Kirshenbaum, director, Health Policy and Systems at (781) 434-7223 (ekirshenbaum@mms.org).