Question

The Resource Based Relative Value Scale (RBRVS) is a prospective payment system established in 1992 by the Centers for Medicare and Medicaid Services (CMS) designed to improve and stabilize the payments made to health care providers.

Application Assignment Instructions

Provide a response to the following questions:

1. What are the three types of RVU's?

2. Explain how CMS determines the national conversion factor for the RBRVS system?

Using the following grid, respond to questions 3-5 below:

3. What is the expected annual income for CPT code 99202?

4. What is the expected annual income for CPT code 99214?

5. How much can the practice expect to receive in payments for all patient types represented on the above grid?

Work PE MP Total Conversion of RVU RVU | RVU Rvu Factor Patients CPT 99202-0fice Visit New, Straightforward 0.88 Medical Decision Making 8 0.79 005 1.72 36.04 600 99203-0fce Visit New, Low Complexity Medical Decision 34 1.13 0.09 2.56 S36.04 99204-Ofco Visit, Now, Modorate 2 1.5 0.12 3.62$36.04 455 Medical Decision 99205-0fce Visit, New, High Complexy Medical Decision Making 2.67 1.78 0.15 4.6 36.04 99211-Office Visit, Est., May Not Require Presence of Physican 0.17 0.39 001736.04 99212-Ofice Visit Est. Straightforward 0.45 0.54 0.031.02 $36.04 Medical Decision 99213-0fice Visit, Est., Low 0.67 0.69 0.03 1.39 36.04 1198 Medical Decision Making 99214-0ffice Visit, Est., Moderate 1.1 1.030.05 2.1836.04 4600 Medical Decision Making 99215-Office Visit, Est, High 1.77 1.32 .08 3.17$36.04 1500 Medical Decision Making

Answer 1

1. RVU is a unit of measure designed to permit comparison of the amounts of resources required to perform various services by assigning weights to those factors.

RVU is divided into 3 elements:-

- Physician work (WORK)

- Physician practice expense (PE)

- Professional liability insurance (PLI)

# Physician work include :

the physicians salary (time the physician spends providing a service and the intensity w/ which that time is spent)

# Physician practice expense include :

overhead costs of the practice

-clinical/admin salary

-rent

-legal/accounting services

3. The expected annual income for CPT code 99202 :-

One case of CPT code 99202 is priced $36.04

Number of procedure with CPT code 99202 in a year = 600

So, 600 cases in a year will cost 600× $ 36.04 = $21624

4. The expected annual income for CPT code 99214

One case of CPT code 99214 is prices $36.04

Number of procedures with CPT code in a year 90214 = 4600

So, 4600 cases in a year will cost 4600× $36.04= $165784

5. The payment expected to be recieved by the practice expert for all the patients types is the sum of the total RVU for all the patient types . It would be 20.83 × $36.04