How we value your work
Every number you see in Occlara traces back to a CMS Physician Fee Schedule rule and the document you uploaded. Here's the pipeline, in plain terms.
- 1 · Performed procedures
Extracted from your uploaded productivity reports. Each line is normalized to a numeric CPT code, modifier set, units, and date of service. Low-confidence extractions are quarantined for review before they enter reconciliation.
- 2 · Earned dollars (CMS PFS)
Each performed line is priced against the CMS Physician Fee Schedule national payment amount for the service date's effective rule (the published Final Rule plus any in-year corrections). Occlara tracks PFS releases (RVU{yy}A–D) and refreshes its reference store on each publication.
- 3 · Credited wRVUs
Read from your compensation statement. Credited wRVU per line is compared to the work-RVU expected for the performed procedure under the value vintage you configure (current-year or frozen anchor-year).
- 4 · Paid dollars
Credited wRVU × the $/wRVU rate from your Contracts under Account. This is what your contract turned into actual pay for that line.
- 5 · Variance
Variance = Earned − Paid. Positive variance indicates the performed work would have been worth more under CMS PFS than the comp model paid. Occlara surfaces and explains the gap; it does not file, appeal, or recommend action.
- 6 · Confidence flags
Each line carries High / Medium / Low confidence reflecting extraction certainty and rule-matching ambiguity. Low-confidence lines should be reviewed before being trusted.
Sources. CMS Physician Fee Schedule (PPRRVU / GPCI files), the employer compensation statement you upload, and your performed-procedure records.
Limitations. Occlara does not parse payer 835/ERA remittances; the "reimbursement vs CMS" lens is a deferred milestone. Comp-vs-hours productivity analysis is out of scope.
Disclaimer. Informational only. Not legal, billing, or compensation advice. CPT® descriptors are displayed under an AMA CPT license; the numeric codes and CMS RVU values are license-free.