Resolved RVU's

[MariaF_75002]

I am still struggling to understand RVU's. Any help, videos or links. We are updating our fee schedule and I'd like more guidance on how to use RVU's to do that. TIA

 

[Lori]

What Measures Are Included in Work RVUs?​

Work RVUs assess physician labor on several levels — accounting for technical skill, physical effort, mental effort, judgment, and stress related to patient outcome. But perhaps the most crucial component factored into work RVUs is the time required to perform a service.

Total work involved in a service or procedure refers to three stages of work, each associated with a unit of time:

• Pre-service work refers to work provided before the service or procedure (e.g., reviewing records, discussing procedures with peers, preparing for surgery).
• Intra-service work refers to work involved in providing the service or performing the procedure. The intra-service period is defined as patient encounter time for an office visit, or the time spent on the patient’s floor for a hospital visit. With surgical procedures, the intra-service time, also called “skin-to-skin” time, is defined as the period between making the first incision and closing the incision.
• Post-service work includes all related work provided after the service is delivered (e.g., post-op care, patient stabilization, recovery room care, updating documentation).

For surgical procedures, the total work period is the same as the global surgical period, including recovery-room time, normal postoperative hospital care, and office visits after discharge, as well as pre-operative and intra-operative work.

All work RVUs assigned to codes express total work and offer a quantitative measure of the time and effort involved with delivering the service.

RVU Calculator - AAPC Relative Value Units

CPT® RVU calculator provides a quick analysis of the work relative value units associated with a certain volume of CPT or HCPCS codes.

www.aapc.com

The new 2022 conversion factor is $34.6062. (The conversion factor is multiplied by the RVUs to calculate the dollar reimbursement amount.) The estimated impact of these and other adjustments on the allergy/immunology specialty is 0.8% overall decrease in Medicare payments for 2022, compared to 2021

Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule | CMS

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022.

www.cms.gov

Here are the steps:

1. Prepare a spreadsheet to calculate the fee per RVU by dividing the total fee by the total RVU for each selected CPT code.

Check to see if your current billing system has updated the RVU information loaded in its fee schedule. If not, you can do so manually by obtaining the 2000 Medicare RVU values from theNov. 2, 1999, Federal Register.

2. After the dollar fee per RVU schedule is completed, sort the schedule in descending order of fee per RVU. "Most procedures should fall within a fairly tight range of approximately $80 to $130 per RVU for a surgery practice and $50 to $80 per RVU for a family practice," notes Kaiser. Procedures with a low fee per RVU relative to this range are potentially underpriced, and procedures with a high fee per RVU are potentially overpriced, he advises.

3. Perform a more detailed payment analysis of a select group of 10 to 20 potentially underpriced and overpriced procedures "If the billing system allows payment analysis by CPT code, run reports for these codes based on a six- to 12-month payment history," he says. "From this detailed payment analysis, it is possible to determine whether payers are currently paying the total fee for these procedures."

4. Adjust fees based on the average fee per RVU. To calculate the practice’s average fee per RVU, determine the total RVUs produced using the most current annual production reports, then divide the total dollar volume by total RVUs produced.

You can use RVUs to set and revise practice fees | 2000-01-01 | AHC…

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