RVU Maximizing Your Reimbursement?
By Kathryne Plato, CPC
Director of Coding at ebix
Proper dictation and coding is a key to maximizing revenues both for your organization and your physicians – especially if you’re using a Relative Value Units (RVU) formula. That’s why the following tips on RVUs are a win-win; share them with your physicians.
First, a quick look at how RVUs are calculated. They’re dependent on the patient encounter being coded accurately and in a timely manner.
- Physician Work RVUs account for the time, technical skill, mental effort and judgment, and stress to provide a service.
- Practice Expense RVUs account for the non-physician clinical and non-clinical labor of the practice, as well as expenses for building space, equipment, and office supplies.
- Professional Liability Insurance RVUs account for the cost of malpractice insurance premiums.
Each of these components is adjusted geographically using separate Geographic Practice Cost Indices (GPCI). The final formula to calculate your area’s specific relative value:
(Practice Expense RV x Practice Expense GPCI) + (Work RV x Work GPCI) + (Malpractice RV x Malpractice GPCI)
5 RVU Tips for Physicians
- Note that if level 3 and level 4 visits are done in the office, your RVUs may be similar to those of a physician who performs many level 1 and level 2 visits in the hospital.
- Know your payer mix and review your contracts to determine your reimbursement. For example, if services you provide target a specific demographic (e.g. the elderly) then the largest payer will be Medicare/MCO (Managed Care Organization).
- Keep up with industry changes to help improve productivity without interrupting the quality of care. For example, 5010 Electronic Billing and EDI Transactions compliance is required by Jan. 1, and the ICD-10 requirement begins Oct. 1, 2013.
- Stay informed on specific payer guidelines to ensure prompt payment. A good start would be to review local and national coverage determinations (LCD/NCD).
- Be certain your practice management system is in accordance with AMA guidelines to create customized reporting.
ebix inc., Greendale, WI, is a revenue cycle management firm offering independent Emergency Room physician groups coding expertise, denials minimization and data analytical services. For an average client, ebix inc. generates an additional 10% of revenue. ebix provides complete, consistent and timely medical coding and billing services, letting physicians focus on the excellence of their patient care, not back room operations. To learn more, please visit www.ebixinc.com