The conversion factor is determined through a highly controversial formula tied to. Just code from the cpt book with a related icd code giving the diagnosis. Most medical supplies, drugs, and devices used in an office procedure are. Because the cost of practicing medicine varies by geographic. Practice expense rvus account for the nonphysician clinical and nonclinical labor of the practice, as well as expenses. After the following components of a service are calculated, an adjust. These include the costs of medical supplies, staff time, and equipment. Each provider determines how much it will charge for services provided. Use aapc rvu calculator and add it to your website. Physician professional payments are based on relative value units rvus that. Calculate the total payment when the conversion factor is 20. This book is a musthave tool for physician practices because it offers invaluable insight and information needed to. Schedule of medical and hospital fees oklahoma workers cec. Rvu calculator widget, aapc medical coding tool, add rvu.
Our work cpt rvu calculator provides a quick analysis of the work relative value units associated with a certain volume of cpt or hcpcs codes. Relative value unit an overview sciencedirect topics. Learn how to calculate medicare payment schedule on rbrvs. The basics of making rvus work for your medical practice.
Relative value units in the medical practice, experts from the coker group a leading healthcare consulting firm give. The work rvu makes up around 53 percent of the total rvu across all procedures with rvu values. Relative value units rvus are a measure of value used in the united states medicare reimbursement formula for physician services. Aapc offers medical coding tools and widgets to help you code fast with precision. There are several factors that affect the amount that will actually be reimbursed. In a midlevel office visit for an established patient, the rvu for the physical work is 1500 and the gpci factor for that physical work is 2 and the rvu for practice expense is 2700 and the gpci factor is 4 similarly the rvu for malpractice insurance cost is 2800 and the gpci is 3. Relative value unit rvu for physician work about 50% of the total relative value. However, if you can look beyond the calculations, youll find that the rvu is actually a good barometer of practice efficiency and patient complexityand it can provide helpful insights into performance, says andy swanson, vice president of consulting services at the medical group.
Andy swanson, vice president of consulting services at the medical group. Associations d codes included in the hcpcs level ii code book. Practice expense pe rvus reflect the cost of nonphysician labor and expenses. The geographically adjusted rvus are then multiplied by a conversion factor that converts the rvu into a dollar amount, which determines the price that medicare. When calculating a relative value unit rvu, its easy to become overwhelmed by the math. As with most things in medicine, the centers for medicare and medicaid. Also includes an excel file of the complete rvu table. Since cpt codes are a of the ama, the association and expects to be paid by those physicians and others who seek to use the codes to understand how they are being paid. Physician work rvus account for the time, technical skill and effort, mental effort and judgment, and stress to provide a service. When calculating a relative value unit rvu, its easy to become. Purchase the book and receive access to the complete rvu table in an excel file format. We start by observing the median level of total compensation. It is calculated based on an estimate of time and effort expended by a provider in performing the procedure or delivering the service associated to the specific procedure code to which the rvu values are assigned. Jan 1, 2006 the schedule of medical fees is based on the most current relative value units rvu produced by the centers the application of these procedure descriptors.