Modeler is a tool that allows you to compare current and proposed changes to your fee schedules. It can compare differences by procedure group and procedure code. This can help you negotiate better rates and understand what a new fee schedule means for you.

Navigate to Modeler by clicking Contract evaluation from the top navigation bar in Rivet, and then click Modeler.

A model in Modeler is called a workbook. To create a model, click Create new workbook in the upper right corner of the Modeler dashboard. Give your new workbook a name.

A reference is the fee schedule, CMS baseline, or flat rate file you would like to serve as your baseline to compare any changes, proposals, or scenarios to.

When you choose to upload a fee schedule, the steps are a bit different than selecting a schedule or baseline already loaded into Rivet. You'll need to drop the file from your computer into the demarcated upload area, and also select an adjustment rule set (already loaded in Rivet) to apply to the rates. This will allow you to turn adjustments on for your workbook that mirror the applicable payer's common adjustment rules.

Next, you'll map the column names from the file you uploaded to Rivet's fee schedule column names. Clicking Next will show you a page where you can review your rates and any errors, and then complete the upload.

The Modeler tool is all about taking a proposed schedule and multiplying its rates against your anticipated volume of claims applicable to that schedule to calculate a dollar revenue amount.

In this step, you're choosing whether you'd like your volume source to come directly from claims (available if you have a claim/remit feed set up) or from a utilization file. If you choose claims, it will default to the last calendar year of claims. For utilization, you can choose an existing file you've already loaded into the Utilization files page of the app, or you can upload a new file.

Applying adjustments is an option you can turn on or off depending on whether you'd like your projected revenue to include the impact of adjustment rules (e.g. multiple procedure reductions, modifier logic, provider discounts, etc.) or exclude those rules and only take base rates into account. Turning on adjustments will result in a more accurate revenue number but will result in longer load times for the model because the system has to run the volume through those rules.

Once you have a reference schedule built out, you can create up to nine comparison schedules. Comparisons follow the same pattern where you can choose a fee schedule, CMS baseline, or fee schedule upload as your starting point.

The key thing about comparisons is that you can edit the fee schedule or baseline rules, as well as edit the volume.

Editing rules allows you to model out a proposal where instead of being reimbursed 110% of CMS RBRVS on surgery codes, you're paid 115%.

Editing volume allows you to model out how your practice's growth or potentially loss of a provider or service might impact your revenue in the future. You can model volume changes by editing the volume as an overall percentage or more granularly by code, code group, provider, or provider taxonomy.

At any point after creating your reference, you can choose to complete the creation of your workbook. From a created workbook, you can add new comparisons, delete existing ones, edit rules, etc.

If you have adjustments turned on and you click Complete, a loading screen will appear indicating how long the system anticipates workbook creation to take. Once a workbook is finished loading, you'll receive an in-app notification as well as an email.

Basic actions regarding a workbook are available by clicking on the three dot menu on the right side of the top name and description bar. These actions include...

Click Actions to open a menu through which you can...

To export a workbook, click the Export button in the upper right corner of the workbook. From there, you'll have the choice to export your current view as a PDF, your current view as a CSV, or a flattened view where if you have any groupings applied, you will export a column for every nested group down to the individual code.

Show, hide, or reorder columns in your workbook the same way you do in other areas of the application by clicking the Columns button and then making your changes within the menu of columns.

You have several options to group the rows of the workbook in order to understand the way revenue is affected by each proposal. When using a procedure code group or provider taxonomy grouped view, you can click into any of the categories (purple text) to drill into nested categories. Options include grouping by...

Click Add filter in the top left of the workbook to filter your model to reflect narrowed volume data. For example, you may want to view your model's results for a single provider or facility type.

If you're using claims as your volume source, you'll see all of the filter options available on All Claims, as that is the data we're pulling from. If you're using utilization as your volume source, the filters will match the properties you've loaded in your utilization file - as long as those properties have full data coverage on the file.

Summary metrics give you an at-a-glance understanding of how your comparisons stack up against your reference schedule. They can be collapsed by clicking the gray Summary stats bar to save space. Summary metrics include...

To drill down into the specifics of codes that were changed (increased/decreased revenue or added/removed as rates), hover and click on the applicable pill. This will filter down the results of the comparison to only include the codes and summary metrics that fit that criteria.

Most actions you can take on a comparison are available by clicking on the three dot menu in the upper right corner of the comparison. Basic actions include...

To view adjustments applying to the full reference or comparison, click View adjustments from the three dot menu in the upper right corner of the reference or comparison. You can then view any category of adjustments being applied.

You can also view the fee schedule rule and/or adjustments applicable to a single row on the reference or comparison by clicking on the applicable rule or adjustment number. This will open a slide out that will tell you which rule and adjustments were applied to that specific code.

To view fee schedule rules for a reference or comparison, click View rules from the three dot menu in the upper right corner of the reference or comparison. You can't edit fee schedule rules for a reference, but you can edit them for a comparison.

If the reference and comparison are based on the same fee schedule, differences between the two will be highlighted in blue.

To edit the volume of the entire comparison or a single row, click Edit volume by % or Edit volume by row from the three dot menu in the upper right corner of the comparison. This is only available for comparisons - volume changes cannot be made for the reference.

There may be a case where the comparison you've modeled in Modeler becomes a real, negotiated schedule. In that case, you can convert that comparison to a fee schedule in Rivet by clicking Add as fee schedule from the three dot menu in the upper right corner of the comparison.

You’ll be able to choose the fee schedule with which to associate the version, and the effective date.

Reorder comparisons on your workbook by clicking and holding the drag icon, and then moving the comparison to the correct position on the workbook.