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6.8 Calculating RBRVS Payments 1. Where do physicians and practices get information on the yearly changes to fee schedules? 2
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Answer #1
  • The physicians and practices get information on the yearly changes to fee schedules from the Centers for Medicare and Medicaid Services (CMS). The CMS determine the RVU for each code and then multiplies it to the annual conversion factor. This lead to the national average fees of the physicians and the practices.
  • The Medicare payment is calculated in five steps. These five steps are:
  1. Standards 20% Co-Pay
  2. Non-participating status and limiting charge
  3. Facility and non-facility rates
  4. Geographic adjustments
  5. Multiple procedure payment reductions (MPPR)
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