Relative Value Units (RVUs/RBRVS) - Articles

So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...
CMS Proposed New E/M Codes for Podiatry
July 16th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
According to CMS changes are coming for E/M codes.  A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ...
Payment Rates Increase for Behavioral Health Office Services
February 13th, 2018 - Wyn Staheli, Director of Research
Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...
Bevy of changes make figuring out 2014 Medicare payments more complicated
January 3rd, 2014 - Scott Kraft
Some years, it is relatively simple to project how your Medicare payments will change for the services rendered. When the only factor in Medicare’s complicated payment formula that changes is the conversion factor, the percentage change in your payment is identical to the percentage change in...
How fees are calculated using RBRVS
March 22nd, 2010 - Codapedia Editor
CPT® codes have three components: Work RVU—this defines the physician work to perform the service. Work RVUs are often used to measure physician productivity. Practice expense RVU—this is a measure of the practice cost to perform the service, including rent, overhead,...
UPDATE CMS ELIMINATES PAYMENT FOR CONSULTS 1-1-2010
January 30th, 2010 - Codapedia Editor
Updated: Dec 16, 2009 By now, we have all heard that CMS will not pay for consuts starting Jan 1, 2010, but we had lingering questions about how to submit claims. Dec 15, CMS released a transmittal, dated Dec 14, 2009, which answers these questions. The transmittal is attached. For services that...
Casting supply codes
March 1st, 2009 - Codapedia Editor
HCPCS codes include temporary codes developed by CMS. Sometimes, the temporary codes stick around for a while. There are HCPCS codes for the provision of cast supplies to Medicare patients. A physician office may always be paid for the cost of the casting materials, whether billing global...

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