AMA CPT® Assistant - 2007 Issue 12 (December)
AMA/Specialty Society RVS Update Process (December 2007)
December 2007 pages 3-6 AMA/Specialty Society RVS Update Process In 1992, Medicare significantly changed the way it pays for physicians' services. Instead of basing payments on the usual, customary, or reasonable charges of providers, the federal government established a standardized physician payment schedule based on a resource-based relative value scale (RBRVS), in which payments for services are supposed to be based on a careful analysis of the resource costs required to provide them. The cost of providing each service has three distinct components: physician work, practice expense, and professional liability insurance. Each component is expressed in units that are...
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Article Overview
This article explains how the AMA/Specialty Society RVS Update Process works and how it fits into Medicare physician payment updates. It is relevant to coders, physician practices, specialty societies, and reimbursement professionals who want to understand the organizations, annual workflow, and review sequence involved in updating relative values tied to CPT and the Medicare Physician Payment Schedule.
Why This Topic Matters
Understanding the RVS update process helps readers follow how relative value recommendations are developed, reviewed, and incorporated into annual payment updates. It also clarifies the roles of AMA, specialty societies, CMS, and related advisory groups in the physician payment system.
Article Sections
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December 2007 pages 3-6
Introductory material and publication context for the article.
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AMA/Specialty Society RVS Update Process
Background on the physician payment framework and the RBRVS system used for Medicare-related valuation.
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The RVS Updating Process
General description of the annual update structure and the committee responsible for recommendations tied to CPT-based services.
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RVS Update Committee
Composition of the committee, including physician specialty representation and allied health participation.
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Advisory Committee
Role of specialty society advisors in reviewing coding changes and contributing recommendations to the committee process.
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The RUC Health Care Professionals Advisory Committee (HCPAC)
Participation of nonphysician professionals in the valuation process and the review board structure supporting that participation.
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RUC Cycle and Methodology
The annual timeline and general steps used to develop, review, and forward relative value recommendations.
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Step 1
Initial transmission of coding actions and preparation of internal summary materials.
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Step 2
Society review of coding changes and selection of a path for responding to the items under review.
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Step 3
Survey distribution and collection of work-related data from practicing physicians.
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Step 4
Specialty society survey review and preparation of recommendations for presentation to the committee.
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Step 5
Presentation of recommendations and committee questioning during the review meeting.
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Step 6
Committee action on recommendations before submission to CMS and referral for additional evaluation when needed.
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Step 7
Transmission of recommendations to CMS and the agency review stage.
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Step 8
Publication timing for the Medicare Physician Payment Schedule and its relationship to the annual update cycle.
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Annual RBRVS Updates, 1993-2008
Summary statistics on the volume of recommendations and CMS acceptance patterns over multiple annual update cycles.
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More Information
Contact and resource information for readers seeking additional details.
What You Will Learn
- How the RVS update process is organized across AMA, specialty societies, and CMS
- How annual valuation recommendations move through committee review and Medicare update timing
- What roles different advisory groups play in the physician payment update workflow
- How the article frames the relationship between CPT-based coding changes and relative value updates
Who Should Read This
- Medical coders
- Physician reimbursement staff
- Practice managers
- Specialty society staff
- Health policy readers
- Compliance professionals
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