rbrvsrbrvs resource based relative value scales. definition of rbrvs financing mechanism reimbursing...

RBRVSRBRVS

Resource Based Relative Value Scales

Definition of RBRVSDefinition of RBRVSDefinition of RBRVSDefinition of RBRVS

• Financing mechanism reimbursing providers on a classification system which measures training & skill required to perform a given health service

RBRVSRBRVSRBRVSRBRVS

• Used to correct Medicare’s tendency to:– Overcompensate for services (e.g.

surgery, diagnostic tests)

– Underpay for primary care services

Three Factors Which Three Factors Which Combined to Force RBRVSCombined to Force RBRVS

Three Factors Which Three Factors Which Combined to Force RBRVSCombined to Force RBRVS

• Dissatisfaction with original payment system

• Escalation of Part B costs

• Promise of credible basis for new payment system

Problems with Previous Problems with Previous SystemSystem

Problems with Previous Problems with Previous SystemSystem

• Customary, prevailing, reasonable system (CPR)

• Some intermediaries had one prevailing charge

• Others had charges based on medical specialty

• Wide variations between physician specialties & geographic regions

TEFRA 1983: TEFRA 1983: Precursor to RBRVSPrecursor to RBRVS

TEFRA 1983: TEFRA 1983: Precursor to RBRVSPrecursor to RBRVS

• Use of a Prospective Payment System (PPS) to pay for hospital care for Medicare patients– Standardized payment for each hospital

admission– Variation according to geographic differences in

wage rates– Variation according to whether hospital is urban

or rural– “Outlier” cases requiring longer LOS permits

higher rate of payment

TEFRA 1983:TEFRA 1983:Precursor To RBRVSPrecursor To RBRVS

TEFRA 1983:TEFRA 1983:Precursor To RBRVSPrecursor To RBRVS

• Admissions are categorized according to 492 DRGs – Payment based on national average

cost for patients with that diagnosis

• Success of DRGs focused attention to physician reimbursement

RBRVS Study: Phase 1RBRVS Study: Phase 1 RBRVS Study: Phase 1RBRVS Study: Phase 1

• Hsiao & Braun conducted a 1985-1988 study to develop RBRVS for 12 medical specialties- Anesthesiology - Family Practice

- General Surgery - Internal Medicine

- OB/GYN - Ophthalmology

- Orthopedic Surgery - Otolaryngology

- Pathology - Radiology

- Urology - Thoracic/

Cardiovascular Surgery

RBRVS Study: Phase 1RBRVS Study: Phase 1RBRVS Study: Phase 1RBRVS Study: Phase 1

• Six additional specialties were funded independently & included in the study- Allergy & immunology

- Dermatology

- Oral & maxillofacial surgery

- Pediatrics

- Psychiatry

- Rheumatology

RBRVS Study: Phase 2RBRVS Study: Phase 2RBRVS Study: Phase 2RBRVS Study: Phase 2

• Added 15 specialties in 1990- Cardiology - Emergency Medicine

- Gastroenterology - Hematology

- Infectious Disease - Nephrology

- Neurology - Neurosurgery

- Nuclear Medicine - Oncology

- Osteopathic Medicine - Radiation Oncology

- Plastic Surgery - Physical Medicine &

- Pulmonary Medicine Rehabilitation

RBRVS MethodRBRVS MethodRBRVS MethodRBRVS Method

1 Total work units for a practice calculated by weighting RBRVS value for each procedure by its function

2 Total practice expenses then divided by total work units to arrive at a cost conversion factor (CCF)

RBRVS MethodRBRVS MethodRBRVS MethodRBRVS Method

3 CCF then applied to specific RBRVS for an individual service & this yields estimate of the relative costs of providing that service in a specific market

4 This estimate applies to physician services to which direct costs cannot be assigned– i.e. visits, consultation, surgical

procedures

RBRVS MethodRBRVS MethodRBRVS MethodRBRVS Method• Method of calculating CCF

__Total Annual Practice Expense__

Total Annual Relative Value Units

– First step in costing is to compile relative values for all prominent procedures performed over a 12 month period

RBRVS MethodRBRVS MethodRBRVS MethodRBRVS Method• Method of calculating CCF (cont.)

– Second step is to total all expenses• Includes physician & staff income,

benefits, practice expenses, malpractice insurance costs

• Excludes any expenses which can be direct-costed

– This is a quick way to determine relative costs by CPT code or for set of codes• i.e. those to be included in a cap rate

Legislation Creating Medicare Legislation Creating Medicare RBRVS Payment SystemRBRVS Payment System

Legislation Creating Medicare Legislation Creating Medicare RBRVS Payment SystemRBRVS Payment System

• OBRA 89: Physician Payment Reform Provisions– Congress enacted new Medicare physician

payment system

– RBRVS narrowed specialty & geographic differences

– Retained some balance billing limits for patients

– Established mechanism of monitoring expenditure increases for the government

Key Features of New SystemKey Features of New SystemKey Features of New SystemKey Features of New System

• Five year transition, commencing January 1, 1992

• Adjust each component of RBRVS for geographic differences

• Eliminate specialty differentials – Medicare payments now the same for

all physicians providing the same services in a locality

• Calculate budget neutral CCF

Key Features of New SystemKey Features of New SystemKey Features of New SystemKey Features of New System

• Establish process for annually updating CCF

• Limit balance billing

• Establish Medicare Volume Performance Standard– Assist Congress in understanding

increased acuity of Medicare services

Four Step Transition to New Four Step Transition to New SystemSystem


• Adjust CPR rates & eliminate specialty differentials

• Historical payment basis decreased by 5.5%– Later increased by 1.9%

– Applied to RBRVS schedule



• Implement new payment schedule– If adjusted historical payment basis

changed by more or less than 15%, payment was adjusted accordingly for that year



• Standardize payment schedules among intermediaries– Currently 28 carriers administer claims

for 211 Medicare localities

– After 1992, carriers no longer had latitude in establishing their own policies governing payments

Scope of RBRVS System Scope of RBRVS System TodayToday

Scope of RBRVS System Scope of RBRVS System TodayToday

• Most physician services now included in RBRVS payment system

• Exceptions:– Medicare patients enrolled in Medicare

HMO

– Some physician services provided in hospitals, SNFs, outpatient rehabilitation facilities, & some services of teaching physicians

Four Major Components of Four Major Components of RBRVS Payment SystemRBRVS Payment System

Four Major Components of Four Major Components of RBRVS Payment SystemRBRVS Payment System

• Relative Value Scale

• Cost Conversion Factor

• Geographic Adjustments

• Limits on Balance Billing– Virtually eliminated

– Balance Billing = billing patient for amount Medicare does not pay

Six Parts of Each RBRVS Six Parts of Each RBRVS Assigned to a CPT CodeAssigned to a CPT CodeSix Parts of Each RBRVS Six Parts of Each RBRVS Assigned to a CPT CodeAssigned to a CPT Code

• Physician Work Required

• Practice Costs

• Professional Liability Insurance

• Work GPCI

• Practice Cost GPCI

• Professional Liability Insurance GPCI

Physician Work ComponentPhysician Work ComponentPhysician Work ComponentPhysician Work Component

• Time required to perform service

• Technical skill & physical effort

• Mental effort & judgment

• Psychological stress associated with physician’s concern regarding iatrogenic risk to patient– Adverse effects induced by physician

during care of patient

Physician Work ComponentPhysician Work ComponentPhysician Work ComponentPhysician Work Component

• Total work performed includes: – Intraservice Work

• Actually providing service or performing procedure

• i.e. office visit, hospital visit, surgical procedure

– Pre-Service Work• Preparing for a procedure

– Post-Service Work• Writing records

Practice Costs ComponentPractice Costs ComponentPractice Costs ComponentPractice Costs Component

• Practice expenses average 41% of total practice revenues

Professional Liability Professional Liability Insurance ComponentInsurance ComponentProfessional Liability Professional Liability Insurance ComponentInsurance Component

• PLI averages 4.8% of practice revenues

Geographic VariationsGeographic VariationsGeographic VariationsGeographic Variations• Calculate using Geographic Practice

Cost Indices (GPCIs)– Work GPCI

• Geographic differences in earning of all professional workers

– Practice Costs GPCI• Differences in rents & employee wages

– PLI GPCI• Geographic differences in premiums for

mature claims made policy providing $1M or $3M limits

Surgery IterationSurgery IterationSurgery IterationSurgery Iteration• Government further specified work

RVUs for surgeons

• Physician work RVUs based on the following activities:– Pre-op visits

– Hospital admission workup

– Primary operation

– Immediate post-op care• i.e. notes, family talk, meetings with other

physicians

Surgery IterationSurgery IterationSurgery IterationSurgery Iteration

• Physician work RVUs based on the following activities: (cont.)

– Writing orders

– Evaluating patient in recovery room

– Post-op follow up on day of surgery

– Post-op hospital & office visits


• Many surgical reimbursements are handled as Global Package– Limits number of post-op services

eligible for separate billings• i.e. dressing changes, incision care,

removal of op packs/sutures/cast/lines/catheters/IV lines/tracheostomy tubing, pain management


• Payment to assistant surgeons– Lower of actual charge or 16% of

global payment amount

Formula For Calculating Formula For Calculating Medicare PaymentsMedicare Payments


• Payments are a function of three key factors:– RBRVS

– GPCIs

– Cost Conversion Factor



• Translates into six component parts:– Physician Work RVUs

– Physician Work GPCI

– Practice Cost RVUs

– Practice Costs GPCI

– PLI RVUs

– PLI GPCI

CPT Code ExplanationsCPT Code ExplanationsCPT Code ExplanationsCPT Code Explanations

• 99211– Office or other outpatient visit

– Established patient

– May not require the presence of a physician

– Presenting problem(s) are minimal

– 5 minutes are spent performing or supervising these services




– Requires at least 2 of these components:• Problem-focused history• Problem-focused examination• Straightforward medical decision making


• 99212 (cont.)

– Counseling and/or coordination of care with other providers/agencies are provided• Based on nature of problem(s) &

patient’s/family’s needs

– Presenting problem(s) are self limited or minor

– Physicians spend 10 minutes face-to-face with patient/family




– Requires at least 2 of these components:• Expanded problem-focused history• Expanded problem-focused examination• Medical decision making of low

complexity


• 99213 (cont.) – Counseling and/or coordination of care

with other providers/agencies are provided• Based on nature of problem(s) &


– Presenting problem(s) are low to moderate severity



• 99245 – Office consultation

– New or established patient

– Requires at least 2 of these components:• Comprehensive history• Comprehensive examination• Medical decision making of high

complexity


• 99245 (cont.) – Counseling and/or coordination of care

with other providers/agencies are provided• Based on nature of problem(s) &


– Presenting problem(s) are moderate to high severity


Calculating RBRVSCalculating RBRVSCalculating RBRVSCalculating RBRVS

• Central Florida GPCIs (1998)

_Work_ Practice Costs__PLI__

0.976 0.946 1.372

Developing An Organization’s Cost Developing An Organization’s Cost Conversion Factor: Conversion Factor: Example #1Example #1


D ETOTAL

WORK UNITS (B x C)

COST PER PROCEDURE

(RVU X CCF)

380 $10.94680 $19.58480 $27.64330 $47.50364 $52.40358 $51.53594 $85.51962 $138.48468 $67.37

$28.79

4,616 X 12 = 55,392 (annualized)$1,594,800 (annualized)

A B C

CPT CODE

FREQUENCY N/12

RBRVS VALUE

(TOTAL RVUs)

1 99211 1,000 0.382 99212 1,000 0.683 99213 500 0.964 99217 200 1.655 99218 200 1.826 99221 200 1.797 99222 200 2.978 99245 200 4.819 99355 200 2.34

101112

(CCF = D11/D10)

TOTAL:TOTAL EXPENSES:

COST CONVERSION FACTOR:



D ETOTAL

WORK UNITS (B x C)

COST PER PROCEDURE

(RVU X CCF)

570 $12.361,360 $22.12960 $31.23825 $53.67

1,456 $59.201,074 $58.232,376 $96.614,329 $156.47936 $76.12


$32.53

A B C

CPT CODE

FREQUENCY N/12

RBRVS VALUE

(TOTAL RVUs)

1 99211 1,500 0.382 99212 2,000 0.683 99213 1,000 0.964 99217 500 1.655 99218 800 1.826 99221 600 1.797 99222 800 2.978 99245 900 4.819 99355 400 2.34

101112

(CCF = D11/D10)



Adapting RBRVS to Central Florida Adapting RBRVS to Central Florida Market: Market: Example #1Example #1


A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS

CENTRAL FL GEOGRAPHIC

ADJUSTED RVU (RVU X GPCI)

CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT99211 Office or Work 0.17 x 0.978 = 0.16626

Outpatient Overhead 0.19 x 0.952 = 0.18088Visit Est. PLI 0.02 x 1.417 = 0.02834

Total Adjusted RVU = 0.37548 x $28.79 =99212 Office or Work 0.38 x 0.978 = 0.37164




Total Adjusted RVU = 0.94217 x $28.79 =

$10.81

$19.19

$27.13



A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT99245 Office Work 2.96 x 0.978 = 2.89488

Consultation Overhead 1.69 x 0.952 = 1.60888PLI 0.16 x 1.417 = 0.22672

Total Adjusted RVU = 4.73048 x $28.79 =99355 Prolonged Work 1.51 x 0.978 = 1.47678

Service, Office Overhead 0.76 x 0.952 = 0.72352PLI 0.07 x 1.417 = 0.09919


$136.19

$66.20



A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT99211 Office or Work 0.17 x 0.978 = 0.16626







$12.21

$21.68

$30.65



A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT99245 Office Work 2.96 x 0.978 = 2.89488

Consultation Overhead 1.69 x 0.952 = 1.60888PLI 0.16 x 1.417 = 0.22672

Total Adjusted RVU = 4.73048 x $32.53 =99355 Prolonged Work 1.51 x 0.978 = 1.47678

Service, Office Overhead 0.76 x 0.952 = 0.72352PLI 0.07 x 1.417 = 0.09919


$153.88

$74.80

Case #1Case #1 5,000 Patients are Expected to Generate an 5,000 Patients are Expected to Generate an

Estimated 3,000 VisitsEstimated 3,000 Visits


Estimated 3,000 VisitsEstimated 3,000 VisitsEXAMPLE #1

CPT CODE # VISITS

COST PER VISIT

ESTIMATED TOTAL

PROJECTED COST

MCO OFFER

PER VISIT

ESTIMATED TOTAL REIMB.

99211 2,000 $10.94 $21,880 $12.00 $24,00099212 500 $19.58 $9,790 $19.00 $9,50099213 200 $27.64 $5,528 $25.00 $5,00099217 100 $47.50 $4,750 $48.00 $4,80099218 100 $52.40 $5,240 $50.00 $5,00099221 50 $51.53 $2,577 $52.00 $2,60099222 20 $85.51 $1,710 $80.00 $1,60099245 20 $138.48 $2,770 $120.00 $2,40099355 10 $67.37 $674 $60.00 $600

3,000 $54,919 $55,500DIFFERENCE = $581




Estimated 3,000 VisitsEstimated 3,000 VisitsEXAMPLE #2

CPT CODE # VISITS

COST PER VISIT

ESTIMATED TOTAL

PROJECTED COST

MCO OFFER

PER VISIT


99211 2,000 $12.36 $24,720 $12.00 $24,00099212 500 $22.12 $11,060 $19.00 $9,50099213 200 $31.23 $6,246 $25.00 $5,00099217 100 $53.68 $5,368 $48.00 $4,80099218 100 $59.21 $5,921 $50.00 $5,00099221 50 $58.23 $2,912 $52.00 $2,60099222 20 $96.61 $1,932 $80.00 $1,60099245 20 $156.47 $3,129 $120.00 $2,40099355 10 $76.12 $761 $60.00 $600

3,000 $62,049 $55,500DIFFERENCE = ($6,549)





• Facts of note:– Group in Example #2 is $7,130 (13%)

more expensive

– MCO wishes to contract with Clinic #1

– Clinic #1 would prefer to channel as many patients as possible to CPT #s 99211, 99217, & 99221

Case #2: Central FL GPCIs IncludedCase #2: Central FL GPCIs Included 5,000 Patients are Expected to Generate an 5,000 Patients are Expected to Generate an




EXAMPLE #1

CPT CODE # VISITS

COST PER VISIT

ESTIMATED TOTAL

PROJECTED COST

MCO OFFER

PER VISIT


99211 2,000 $10.81 $21,620 $12.00 $24,00099212 500 $19.19 $9,595 $19.00 $9,50099213 200 $27.13 $5,426 $25.00 $5,00099245 20 $136.19 $2,724 $120.00 $2,40099355 10 $66.20 $662 $60.00 $600

2,730 $40,027 $41,500DIFFERENCE = $1,473





EXAMPLE #2

CPT CODE # VISITS

COST PER VISIT

ESTIMATED TOTAL

PROJECTED COST

MCO OFFER

PER VISIT


99211 2,000 $12.21 $24,420 $12.00 $24,00099212 500 $21.68 $10,840 $19.00 $9,50099213 200 $30.65 $6,130 $25.00 $5,00099245 20 $153.88 $3,078 $120.00 $2,40099355 10 $74.80 $748 $60.00 $600

2,730 $45,216 $41,500DIFFERENCE = ($3,716)





• Facts of note:– Group in Example #2 is $5,189 (13%)

more expensive

– MCO wishes to contract with Clinic #1

– Clinic #1 would prefer to channel as many patients as possible to CPT # 99211

Incentives for Physicians to Incentives for Physicians to ParticipateParticipate


• Full payment schedule of non-participating physicians set at 95% of full payment schedule for participating physicians

• Directory of participating physicians sent to seniors



• Participating physicians provided with toll-free transmission lines if they transmit a percentage of claims electronically

• Participating physicians assisted by Medicare intermediaries with simplified billing procedures for Medigap coverage

Forces Driving Private Third Forces Driving Private Third Party Payers to Implement Party Payers to Implement

RBRVSRBRVS


RBRVSRBRVS

• Encourages use of primary care services

• Keeps up with practices being selected by self-insured employers

• Keeps up with cost savings realized by competitors using RBRVS


RBRVSRBRVS


RBRVSRBRVS• Prevent doctors from raising fees to

insurers & cost shifting fee cuts from Medicare to private insurance

• Desire to reduce services payments perceived as overpriced

Other RBRVS ExamplesOther RBRVS Examples

Costs Estimated Under RBRVS vs. Comparative Expectation of Reimbursements Based Upon a Consistent Rate of Contractual

Allowance

Example: OUCH Example: OUCH Cost Conversion Factor for Outpatient Cost Conversion Factor for Outpatient

Counseling ServicesCounseling Services

Example: OUCH Example: OUCH Cost Conversion Factor for Outpatient Cost Conversion Factor for Outpatient

Counseling ServicesCounseling ServicesD E

TOTAL WORK UNITS

(B x C)

COST PER PROCEDURE

(RVU X CCF)

380 $3.28670 $5.791460 $12.612930 $25.322310 $19.962820 $24.37870 $7.52710 $6.131350 $11.66


$8.64

A B C

CPT CODE

FREQUENCY N/12

RBRVS VALUE

(TOTAL RVUs)

1 99211 1,000 0.382 99212 1,000 0.673 99214 1,000 1.464 90801 1,000 2.935 90844 1,000 2.316 90847 1,000 2.827 90849 1,000 0.878 90853 1,000 0.719 90862 1,000 1.35

101112

(CCF = D11/D10)



Example: OUCH Example: OUCH RBRVS Values with GPCIsRBRVS Values with GPCIs


A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

99211 Outpatient Work 0.17 x 0.978 = 0.17Visit Est. Overhead 0.19 x 0.952 = 0.18

Client PLI 0.02 x 1.417 = 0.03Total Adjusted RVU = 0.38 x $8.64 =

99212 Office or Work 0.38 x 0.978 = 0.37Outpatient Overhead 0.28 x 0.952 = 0.27

Visit Est. Client PLI 0.02 x 1.417 = 0.03Total Adjusted RVU = 0.67 x $8.64 =



90801 Psychiatric Work 2.21 x 0.978 = 2.16Diagnostic Overhead 0.67 x 0.952 = 0.64Interview PLI 0.09 x 1.417 = 0.13


C E

PAYMENT SCHEDULE

AMOUNT

$3.28

$5.79

$12.61

$25.32



90844 Individual Work 1.73 x 0.978 = 1.69Medical Overhead 0.54 x 0.952 = 0.51

Psychotherapy PLI 0.08 x 1.417 = 0.11Total Adjusted RVU = 2.31 x $8.64 =

90847 Family Medical Work 2.21 x 0.978 = 2.16Psychotherapy Overhead 0.58 x 0.952 = 0.55

PLI 0.08 x 1.417 = 0.11Total Adjusted RVU = 2.82 x $8.64 =

90849 Multiple Family Work 0.59 x 0.978 = 0.58Psychotherapy Overhead 0.26 x 0.952 = 0.25with Physician PLI 0.03 x 1.417 = 0.04

Total Adjusted RVU = 0.87 x $8.64 =90853 Group Work 0.43 x 0.978 = 0.42

Psychotherapy Overhead 0.26 x 0.952 = 0.25with Physician PLI 0.03 x 1.417 = 0.04


A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT

$19.96

$24.37

$7.52

$6.13



90862 Pharmacologic Work 0.95 x 0.978 = 0.93Management Overhead 0.37 x 0.952 = 0.35

w/Prescription PLI 0.05 x 1.417 = 0.07Total Adjusted RVU = 1.35 x $8.64 =

A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT

$11.66

Example: OUCH Example: OUCH Estimate of Charge & Cash Receipts Per MonthEstimate of Charge & Cash Receipts Per Month

Example: OUCH Example: OUCH Estimate of Charge & Cash Receipts Per MonthEstimate of Charge & Cash Receipts Per Month

A B C D E

CPT CODE FREQUENCY

COST PER PROCEDURE

TOTAL BILLED

CHARGES (B x C)

TOTAL ESTIMATED RECEIPTS

(D x 0.40)

99211 1,000 3.28 $3,280 $1,31299212 1,000 $5.79 $5,790 $2,31699214 1,000 $12.61 $12,610 $5,04490801 1,000 $25.32 $25,320 $10,12890844 1,000 $19.96 $19,960 $7,98490847 1,000 $24.37 $24,370 $9,74890849 1,000 $7.52 $7,520 $3,00890853 1,000 $6.13 $6,130 $2,45290862 1,000 $11.66 $11,660 $4,664

TOTAL 9,000 $116,640 $46,656Average Billed Charge = (D/B) = $12.96

Average Cash Received/Billed Charge = (E/B) = $5.18

Example: RIP Example: RIP Cost Conversion Factor for Outpatient Cost Conversion Factor for Outpatient

Counseling ServicesCounseling Services

Example: RIP Example: RIP Cost Conversion Factor for Outpatient Cost Conversion Factor for Outpatient

Counseling ServicesCounseling ServicesA B C D

CPT CODE

FREQUENCY N/12

RBRVS VALUE

(TOTAL RVUs)

TOTAL WORK UNITS

(B x C)

1 99211 1,000 0.38 3802 99212 1,000 0.67 6703 99214 1,000 1.46 14604 90801 1,000 2.93 29305 90844 1,000 2.31 23106 90847 1,000 2.82 28207 90849 1,000 0.87 8708 90853 1,000 0.71 7109 90862 1,000 1.35 1350

101112

(CCF = D11/D10)

$18.52




D ETOTAL

WORK UNITS (B x C)

COST PER PROCEDURE

(RVU X CCF)

380 $7.04670 $12.411460 $27.042930 $54.262310 $42.782820 $52.23870 $16.11710 $13.151350 $25.00

$18.52


Example: RIP Example: RIP RBRVS Values with GPCIsRBRVS Values with GPCIs


A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

99211 Outpatient Work 0.17 x 0.978 = 0.17Visit Est. Overhead 0.19 x 0.952 = 0.18

Client PLI 0.02 x 1.417 = 0.03Total Adjusted RVU = 0.38 x $18.52 =





90801 Psychiatric Work 2.21 x 0.978 = 2.16Diagnostic Overhead 0.67 x 0.952 = 0.64Interview PLI 0.09 x 1.417 = 0.13


C E

PAYMENT SCHEDULE

AMOUNT

$7.04

$12.41

$27.04

$54.26



90844 Individual Work 1.73 x 0.978 = 1.69Medical Overhead 0.54 x 0.952 = 0.51

Psychotherapy PLI 0.08 x 1.417 = 0.11Total Adjusted RVU = 2.31 x $18.52 =

90847 Family Medical Work 2.21 x 0.978 = 2.16Psychotherapy Overhead 0.58 x 0.952 = 0.55

PLI 0.08 x 1.417 = 0.11Total Adjusted RVU = 2.82 x $18.52 =

90849 Multiple Family Work 0.59 x 0.978 = 0.58Psychotherapy Overhead 0.26 x 0.952 = 0.25with Physician PLI 0.03 x 1.417 = 0.04

Total Adjusted RVU = 0.87 x $18.52 =90853 Group Work 0.43 x 0.978 = 0.42

Psychotherapy Overhead 0.26 x 0.952 = 0.25with Physician PLI 0.03 x 1.417 = 0.04


$42.78

$52.23

$16.11

$13.15

A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT



A B D

CPT CODE

SHORT DESCRIPTOR

RVU COMPONENTS



CONV. FACTOR

C E

PAYMENT SCHEDULE

AMOUNT90862 Pharmacologic Work 0.95 x 0.978 = 0.93

Management Overhead 0.37 x 0.952 = 0.35w/Prescription PLI 0.05 x 1.417 = 0.07

Total Adjusted RVU = 1.35 x $18.52 = $25.00

Example: RIP Example: RIP Estimate of Charge & Cash Receipts Per MonthEstimate of Charge & Cash Receipts Per Month

Example: RIP Example: RIP Estimate of Charge & Cash Receipts Per MonthEstimate of Charge & Cash Receipts Per Month

A B C D E

CPT CODE FREQUENCY

COST PER PROCEDURE

TOTAL BILLED

CHARGES (B x C)

TOTAL ESTIMATED RECEIPTS

(D x 0.40)

99211 1,000 $7.04 $7,040 $2,81699212 1,000 $12.41 $12,410 $4,96499214 1,000 $27.04 $27,040 $10,81690801 1,000 $54.26 $54,260 $21,70490844 1,000 $42.78 $42,780 $17,11290847 1,000 $52.23 $52,230 $20,89290849 1,000 $16.11 $16,110 $6,44490853 1,000 $13.15 $13,150 $5,26090862 1,000 $25.00 $25,000 $10,000

TOTAL 9,000 $250,020 $100,008Average Billed Charge = (D/B) = $27.78

Average Cash Received/Billed Charge = (E/B) = $11.11

rbrvsrbrvs resource based relative value scales. definition of rbrvs financing mechanism reimbursing...

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