Specialty reconstruction
Rebuild the proposed national result using CMS utilization and payment inputs. This explains the policies, service categories, and codes behind a specialty estimate.
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
Apply the same payment logic to one organization's CPT volume, locality, sites of service, and Medicare-linked commercial contracts.
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
Apply the proposed RVUs, conversion factors, and policy changes at the code and site-of-service level.
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 estimate.
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.
- CPT utilizationCodes, units, and service mix
- LocalityGeographic payment adjustments
- Site of serviceOffice and facility payment differences
- Contract termsMedicare tiebacks, effective dates, and payer products
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.
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.
Fulcrum can turn a CPT utilization file into a practice-specific forecast within 72 hours after a BAA is signed.