accept NO responsibility for any conflicts you may have with HCFA or Medicare carriers based on the use of this template.
I am interested in your comments and suggestions. Please write to:
Neil Gaston, R.N.
NXc/o Larry W. Weidner, M.D.
301 South Boulevard, Suite 119
Edmond, OK 73034
(405)348-0913
RVU'sB
Click to Return
sement is, at best, confusing BNboth to the provider and the regional Medicare carrier. For this
reason it be
er Help)].
8. Enter Conversion Factor (as of 12/25/91: $31.001). This item can also be entered as an "auto entry function."
Entering the above items will yield the "new" Medicare payment. HOWEVER: There J
is a "Transition Factor." Based on the "Average Historical Payment Basis" (AHPB - the average payment to providers in your region for a particular procedure during the preceding year), the final payment may b
frustrated by the typical government "mumbo-jumbo" listed above. These items are listed in the Federal Register and will be republished each year as they are updated. As of 12/25/91, the current list of RVUs H
may be found in Vol. 56, No. 227 / November 25, 1991 of the Federal Register. Items 5 through 7 remain constant to the provider's geographical region and can be entered as an "auto entry function" (see Filemak
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Geneva
e adjusted. Therefore:
9. Enter the AHPB (available from your regional Medicare carrier). This will calculate to the penny the maximum allowable payment for the given procedure.
DISCLAIMER:
I hope that you L
find this template of use in trying to make sense out of the new RVU system. Please use it for what it is
a tool. Keep in mind that HCFA is next to the Almighty Himself and what HCFA says
goes! I hereby
/e found in Vol. 56, No. 227 / November 25, 1991
Conversion
Factor
Payment
Transition
Adjusted
Payment
E0Medicare Payments Bases on Relative Value Units
Click for
GPCIw
GPCIpe
Pro 1.0F!
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RVU HelpB
hedule for payments based on "Relative Value Units." This new system of reimbursement is, at best, confusing b
4. Enter RVUm (Malpractice relative value units for the service)
5. Enter GPCIw (GPCI value reflecting one-fourth of geographic variation in physician work applicable in the fee F
schedule)
6. Enter GPCIpe (GPCI value for practice expense applicable in the fee schedule area)
7. Enter GPCIm (GPCI value for malpractice expense applicable in the fee schedule area.
[NOTE: Don't be
1ulevard, Suite 119
Edmond, OK 73034
(405)348-0913
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CUdt -
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0ll allow the provider an easy route to accomplish this task. In addition, HCFA plans to update these RVU's on an annual basis. This allows the provider the opportunity of recalculating fees without waiting
will allow the provider an easy route to accomplish this task. In addition, HCFA plans to update these RVU's on an annual basis. This allows the provider the opportunity of recalculating fees without waiting D
on the inevitably "late" official notifications.
Here's how it works:
1. Enter procedure code
2. Enter RVUw (Physician work relative value units for the service)
3. Enter RVUpe (Practice expense relative valu
Relative Value Unit Formulation
As of January 1, 1992, HCFA will institute the new Medicare fee schedule for payments based on "Relative Value Units." This new system of reimbursement is, at best, confusing bB
oth to the provider and the regional medicare carrier. For this reason it behooves the provider to double check the regional reimbursement rates by personally calculating the payments.
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