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Ambulatory_Reimbursement_Systems_1_

Ambulatory_Reimbursement_Systems_1_ - AnIntroduction...

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Resource-Based Relative Value  Scale for Physician Payments An Introduction
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Resource-Based Relative Value  Scale  (RBRVS) Federal Payment System for Physicians  across Continuum of Care System of Classifying Health Services Based on: Cost of Furnishing Physician Services in  Different Settings, Skills and Training Levels Required to  Perform the Services, and  Time and Risk Involved
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History of RBRVS Concept of Relative  Value Scale (RVS)  Dates from 1940s RVS Represents  Worth of Healthcare  Services Multiple Views of  “Worth” Historical Charges Amt. Patients Will  Pay Physicians’  Assessments of  Worth Monetized Societal  Good Micro-costing from  Time & Motion  Studies
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History of RBRVS (cont.) Consolidated  Omnibus  Reconciliation Act  (COBRA) of 1985:   HHS Directed to  Develop RVS;  OBRA 1989  mandated use of  RBRVS Purpose Decrease Medicare  Part B Payments Eliminate Inequities  in Payments Specialty Type of Procedure Geographic Locality Service Site Carrier Policies
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History of RBRVS (cont.) 1-1-1992 RBRVS  Effective (Phase-In  Through 1996) Controlled Fee-for- Service System  Based on CMS’s  Estimation of Value  of Physician  Services (Not PPS) Services Physician Medical/Surgical Diagnostic Radiologic Physical &  Occupational  Therapy Physician Assistant Nurse Practitioner Nurse Midwife
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Structure of Relative Value Units  (RVUs) CPT Codes  Assigned Relative  Value Units  RVUs Permit  Comparison of  Resources by  Assigning Weights  to Personnel Time,  Level of Skill, &  Technology National Averages RVU Elements Time & Intensity of  Work (Physician  Work, WORK) Cost of Practice  (Physician Practice  Expense, PE) Risk of Malpractice  (MP)
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Structure of RVUs (cont.) WORK Covers Physician’s  Salary Time Intensity Mental Effort &  Judgment Technical Skill Physical Effort Psychological  Stress
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Structure of RVUs (cont.) PE Overhead Costs of  Practice Office Rent Wages of  Nonphysician  Personnel Supplies &  Equipment Two Rates Facility (Hospital,  etc.) Lower Nonfacility (Physician  Office) Higher MP Cost of Premiums for  Professional Liability  (Malpractice)  Insurance
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Payment Structure RVU Geographic Practice  Cost Index (GPCI) Adjustment for  Geographic  Differences in Costs Each Element of  RVU Has Unique  GPCI WORK PE MP Conversion Factor Converts RVU into  Medicare Payment Conversion Factor is  Across-the-Board  Multiplier (Constant) CMS Determines  Annually and Notifies  in  Federal Register
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Payment Structure New Orleans, LA Work GPCI = 1.000
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