The Reddenda Commercial Reimbursement Index
RCRI reduces the commercial price of a physician office visit in America to one bounded number, measured against the Medicare fee schedule and printed on a fixed calendar. This document is the full construction. Every dollar-adjacent claim it contains is a documented reimbursement opportunity, modeled not guaranteed.
1. What RCRI measures
RCRI is the equal-weighted mean, across an eight-code basket of office evaluation-and-management visits, of each code’s national multiple of the Medicare Physician Fee Schedule. A value of 1.00x means commercial contracts pay, at the median, exactly the Medicare rate; the baseline print of 0.9608x means they pay about 96 cents on the Medicare dollar.
RCRI is not paid claims. It is not a measure of care quality, access, or outcomes. It is not a payment guarantee for any individual practice. It is a price index built from contracted rates, and it describes the market, not any one contract.
2. The basket
The basket is eight codes: the four new-patient office visits 99202, 99203, 99204, 99205, and the four established-patient office visits 99212, 99213, 99214, 99215. Office E/M was chosen because it is universal and specialty-agnostic: almost every physician who sees patients bills these codes, so the index is not skewed toward one specialty’s procedure mix.
The basket is frozen. It changes only through a versioned rebalance, announced in advance with a posted consultation window, and a rebalance mints a new methodology version rather than silently restating old prints.
3. Construction
Per state and code, the multiple is the median across the full verified distribution of practice-level contracted rates for that code in that state, divided by the code’s Medicare denominator. A state-code cell publishes only when it clears the suppression floor: n ≥ 11 verified rate points with a non-degenerate spread. The national per-code multiple is the median across the states that clear. RCRI is the equal-weighted mean of the eight national per-code multiples.
Weights are equal and disclosed. Utilization weighting, which would tilt the basket toward the codes physicians bill most, is under consideration for v2 and is not applied in v1.
4. The denominator
The denominator is the CMS Physician Fee Schedule CY2026 national non-facility schedule. It is frozen per vintage, so that a print reflects the market against a fixed yardstick. When CMS changes the fee schedule, the affected print carries a decomposition that separates denominator-driven movement from market-driven movement, so a change in Medicare is never mistaken for a change in commercial behavior.
Locality-adjusted denominators, which would price each market against its own geographically adjusted Medicare rate, are a versioned future upgrade and are not applied in v1.
5. Payer composition
Rates come from federally mandated Transparency-in-Coverage disclosures: the national carriers UnitedHealthcare, Aetna, and Cigna, plus the regional Blue Cross Blue Shield plans gated to their home states. BlueCard spillover, where an out-of-state Blue plan appears in a market it does not primarily serve, is excluded. Synthetic rollup keys, which aggregate across payers in ways that would double-count, are excluded.
6. What TiC data is and is not
Transparency-in-Coverage machine-readable files publish contracted prices, not adjudicated claims. They carry a known limitation we own plainly: ghost rates, where a payer lists a price for a code a given provider does not actually bill. We gate against the two failure modes we can detect: wrong-unit rows, where a rate is published in the wrong basis, and malformed flat-file rows that do not parse to a clean price. Rates that fail those gates do not enter the distribution.
7. Revision policy
A published print is never silently restated. If we find an error, the print carries a visible errata flag with a dated scope and a stated cause, and the corrected value sits beside the original. A period we cannot print is marked skipped. We never interpolate a missing print.
8. Release calendar
RCRI prints quarterly, on the third Tuesday of the second month after quarter close. The forward calendar is printed in advance: the first quarter print is Tuesday, November 17, 2026, followed by February 16, 2027, May 18, 2027, and August 17, 2027. Graduation to a monthly cadence happens only after four consecutive on-time quarterly prints.