Clarify what each contract pays
Resolve payer products, Medicare base years, carveouts, and effective dates. See which contracts pass Medicare changes through, which remain fixed, and the annual revenue impact.
Practice financial intelligence
Fulcrum for Ophthalmology.
Plan for payment changes, negotiate with market evidence, and identify likely underpayments. Fulcrum analyzes your written contracts, claims data, and payer-supplied rate data to help you forecast through shifting fee schedule environments.
Financial visibility for Ophthalmology
Diagnostics, drugs, and surgery reimburse differently.
Fulcrum gives ophthalmology finance teams a product-level view of expected payment, contract changes, and revenue exposure across the services that drive the practice.
Fulcrum Light
Turn your contracts and claims into a plan.
Start with a claims export and your contract set. Fulcrum adds payer-published in-network rates to model your payment exposure and compare your position in the market. No EMR integration required.
Plan for revenue changes
Forecast claim-line changes by service, location, and provider. Toggle proposed policies, compare scenarios, and save analyses to rerun when your data changes.
Negotiate with market evidence
Compare rates with other groups contracted with the same payer, by insurance product. Model proposals on your volume and use monthly rate history to inform contracting and growth decisions.
Focus underpayment review
Check claims against contract terms and payer-published rates, then review EOB evidence to screen false positives. Continuous service includes a monthly report, appeal evidence, and next steps.
What becomes answerable
Move from reported revenue to financial context.
- 01Which contracts pass Medicare changes through, and when?
- 02Which payments need underpayment review?
- 03How will a proposed rate change affect revenue?
- 04Where do our rates lag the market?
CY 2027 proposed PFS
What the proposed rule could change.
A national specialty average is useful context, not a practice forecast. Your result depends on your codes, volume, locality, sites of service, and Medicare-linked contracts.
-2.9%CMS RVU-based estimate
-3.2%Fulcrum reconstruction
Proposed change in RVU-based allowed charges, before the separate conversion-factor adjustment.
CMS's projected overall impact for Ophthalmology
CMS's own reconciliation table (Table D-B5) puts ophthalmology at -2.9% for 2027. That figure is the specialty-wide, volume-weighted change in total RVU-based allowed charges: the aggregate gain or loss across every code the specialty bills, before the separate conversion-factor cut. Fulcrum's reconstruction estimates -3.2%, a net reduction of $147 million in national allowed charges.
Ophthalmology bills about 74% of its Medicare dollars in the office (non-facility) setting. By site of service, the 2027 change splits as follows:
| Site of service | Change | Allowed $ |
|---|---|---|
| Office (non-facility) | -3.6% | -$121M |
| Facility | -2.3% | -$27M |
All figures are national, hold 2025 utilization fixed, and exclude the separate conversion-factor adjustment. CMS proposes a 1.68% reduction for non-qualifying APM participants and a 1.19% reduction for qualifying APM participants. These adjustments are separate from the RVU-based changes shown above.
The charts exclude conversion-factor changes. The −1.68% adjustment noted in the category chart applies to non-qualifying APM participants; the proposed adjustment for qualifying participants is −1.19%.
How impact varies by practice.
How Fulcrum models the PFS →
The specialty average hides a wide spread, and CMS's own practitioner-level file proves it. 41% of ophthalmology practitioners land in the -2 to -1% band, and about 35% see a cut deeper than 2%. Where a practice lands is a question of service mix: the ophthalmology practices hit hardest are those with the most high-overhead office imaging and testing, plus cataract volume.
Practice-specific analysis
See your practice’s revenue impact.
Choose a one-time analysis or continuous planning with Fulcrum Light. Both start with your claims and contracts; no EMR integration is needed.