Specialty reconstruction
Reconstruct proposed changes in RVU-based allowed charges using CMS utilization and payment-policy inputs. These published specialty figures exclude the separate conversion-factor adjustment.
Fulcrum Research
From a national estimate to a practice-specific forecast.
Fulcrum reconstructs how a Medicare fee-schedule update changes payment, then applies that logic to the services a practice actually delivers. The national specialty estimate is context. CPT mix, locality, sites of service, and contract language determine the practice result.
The distinction
Two related analyses. Two different answers.
Practice forecast
Reprice the practice's own claim lines using the applicable conversion factor, locality, site of service, provider credentials, and modifiers. Follow the result through each commercial contract's terms.
How the model works
Four steps from source files to financial impact.
Establish the baseline
Start with CMS utilization, payment files, the current fee schedule, and the published specialty estimate.
Reprice the services
For the national RVU-based comparison, hold the conversion factor constant and apply proposed RVUs and payment policies by code and site of service. Apply the appropriate conversion factor separately in a practice forecast.
Hold utilization constant
Use the same service volume on both sides so the result isolates the rule change rather than a change in clinical activity.
Aggregate and reconcile
Roll code-level changes into service categories and specialties, then compare the reconstruction with CMS's published estimates and available provider-level forecasts.
Practice-specific inputs
The forecast becomes yours when the utilization does.
For a practice analysis, Fulcrum replaces the national utilization basis with the organization's own data and follows the Medicare update through the contracts tied to Medicare logic.
- Claims and utilizationCPT codes, units, modifiers, and provider credentials
- Locality and settingGeographic adjustments and office or facility rates
- Written contractsPayer products, Medicare base years, effective dates, and carveouts
- Published payer ratesExternal rate checks and market comparisons
Scenarios and validation
Make the assumptions visible.
Compare proposed policies individually or in combined scenarios, with each revenue shift tied to its source and regulatory status. Commercial forecasts follow the contract’s reference year and update timing; a Medicare change does not automatically reprice every agreement.
Fulcrum tests forecasts against prior Medicare rules and CMS reference forecasts. Contract terms extracted through OCR are reviewed by a human and checked against payer-published rates. Sources and assumptions stay attached to the analysis so the result can be reviewed.
Interpretation and limits
What the figures do and do not mean.
Proposed is not final. Proposed-rule figures may change before the final rule takes effect.
Conversion factors are separate. CMS proposes a 1.68% reduction for non-qualifying APM participants and a 1.19% reduction for qualifying participants. The specialty percentages shown on this site exclude these adjustments; a practice forecast applies the relevant factor separately.
National estimates simplify geography. Fulcrum's national specialty reconstruction uses CMS's published utilization basis and geographic indices of 1.0 unless stated otherwise.
Utilization is held fixed. The model isolates payment-policy effects. It does not predict changes in volume, coding behavior, or clinical mix.
Commercial impact depends on the contract. Medicare-linked rates move according to each agreement's language, timing, and fee-schedule reference.
The output is an analytical estimate. It is not a payment guarantee or a substitute for legal or contractual interpretation.
Primary sources
Start with CMS.
Your practice
See where your own service mix lands.
Start with a claims export and your contract set. Fulcrum Light forecasts Medicare and commercial impact without an EMR integration.