Maximizing RVUs by ju5Vkd41

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									Maximizing RVUs
   CPT Mary L. Reed
  Kamish Health Clinic
  Fort Wainwright, AK
Kamish Health Clinic
Goals and Objectives

• Understanding terminology
• Understand how RVUs are calculated
• Understand why RVUs matter
• Improve clinic performance
What is an Encounter?

• A face to face contact between patient
  and provider
• One value
What is a RVU?

• Relative Value Unit
• Measurement of the resources required to
  provide a particular service/procedure
• Assigns numerical values to health care
  services
• Used by third party payers and HMOs
History of RVU
• 1980s – Rising Medicare spending
• 1986 – Physician Payment Review
  Commission
• 1988 – Hsiao – develops new fee based
  schedule
• 1992 – HCFA implemented RBRVS based
  fee schedule for reimbursement
• Medicare payments for FP increased by
  36%
RVUs

• Guides reimbursement
• Quantifies work that providers do
• Attempts to measure provider productivity
• Can be based on per hour work, per clinic
 session or per FTE
What is a FTE?

• Full Time Equivalent
• Reflect RVUs more accurately in most MHS
  – Variations in clinical environment
     • Clinical and non-clinical responsibilities
     • Academic medicine
     • Inpatient, obstetrics, outpatient care
• Based on an 8 hour work day
How are RVUs Calculated?

• Physician Work RVU
• Practice Expense RVU
• Malpractice Expense RVU
Physician Work RVU

• Time, effort, intensity required on
 physician’s part
Practice Expense RVU

• Direct and indirect expenses to perform
 services/procedures
  – Non-physician labor, supplies, equipment,
    utilities
Malpractice Expense RVU

• Intent is to apply a heavier weight to
 those specialties with higher malpractice
 costs
Other factors

• GPCI
  – Geographical Practice Cost Index
• Conversion Factor
  – Nationally uniform
  – Converts RVUs into payment amount
In Civilian Sector

• How does one calculate a payment from
 RVUs?
Compute Payment
RVU Physician Work x GPCI for Physician Work
  + RVU Practice Expense x GPCI for Practice
  Expense
  + RVU Malpractice Expense x GPCI for
  Malpractice Expense
= Total RVUs
  X Conversion Factor
= Payment amount
In MHS Environment

• No Practice Expense
• No Malpractice Expense

• RVU = RVU Physician Work
MHS Goals – 2003
               RVUs/FTE
   ARMY        15.4

   NAVY        14.9

   AIR FORCE   13.2

   MHS TOTAL   14.5
Why RVUs?

• Measures provider productivity
  – Monitor resources needed for patient care
  – Monitor individual performance
• Evaluates a particular clinic service
• Standardized measure that can compare a
  wide range of services across specialties
• Guides third party billing
Impact of RVU Fee Schedule on Medicare
Reimbursement by Specialty (1991-1997)

Specialty           Total Impact on
                    Medicare Payment
CT Surgery          -9.3 %
Cardiology          -15 %
Family Practice     +36 %
Ophthalmology       -18.4 %
Dermatology         +9 %
GI                  -14.4 %
Internal Medicine   +16.5 %
RVUs/FTE
• #pts seen w/ 99213 x 0.67 = x
• #pts seen w/ 99214 x 1.09 = y
• #pts seen w/ 99395 x 1.35 = z
• Add up total RVUs (x+y+z…)
• Divide total clinic hours reported on
  UCAPERS by 8 (work day) = $FTE-days
• Divide total RVUs by $FTE-days
Consideration Factors

• RVUs = RVU physician Work
• RVUs are highly based on coding
Common E&M codes

E&M     RVU pw   RVU total

99212   0.45     0.45

99213   0.67     0.67

99214   1.09     1.09

99215   1.76     1.76
Common E&M codes
E&M       RVU pw   RVU total
99391     1.01     1.01
99392-3   1.18     1.18
99394-5   1.35     1.35
99396     1.52     1.52
99397     1.7      1.7
RVUs and Coding

• E&M
• CPT
Briefly on Coding

• Differences in E&M coding
• 3 key factors
  – History
  – Physical examination
  – Decision making
  – Other (education/counseling – if >50%)
Essentials

• Documentation
• Accurate coding
• Well rounded appointment structure
MHS is working to facilitate
these factors
• T-Nex
• ICDB
• CHCS2
Old stand-bys

• Pre-formatted notes
• Dictation system
More…

• Decrease no show rates
• Decrease cancelled appointment rates
• More education on accurate coding
• Continuity with primary care providers
Things to consider

• Open access clinic system
Limitations of RVUs

• Does not take into consideration the
  behind the scenes work done outside of
  the appointment
• Reviewing reports/records
• Coordinating care with consultants
• Documentation based – lower RVUs
Conclusion

• Meet and exceed MHS Goals
  – Improve coding accuracy
  – Improve documentation
  – Decrease no-shows/cancelled appts
• RVUs are not perfect
References
• Easter, Deborah. Utilization Management Coordinator,
    MCXP-RMD-MC. 10Jul2002.
•   Johnston, Sarah E., Newton, Warren P. Resource-based
    Relative Value Units: A Primer for Academic Physicians.
    Family Medicine, March 2002.
•   Performance Plan Between Deputy Secretary of Defense
    and Assistant Secretary of Defense (Health Affairs) FY
    2003-2007. 08Aug2002.
•   Henley, Douglas E. Coding Better for Better
    Reimbursement. Family Practice Management – Jan
    2003.

								
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