decisionhealth Newsletters, Part B News - 2004 Issue 11 (November)
Five-year review: More on CMS's plan to choose high vol-ume codes to be included in the next five-year review of work RVUs
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Article Overview
This article explains CMS’s planned method for selecting physician services for review in the next five-year RVU cycle, including a focus on high-volume services, site-of-service shifts, and nominations from specialties and individual clinicians. It is relevant to physicians, coding and reimbursement professionals, practice managers, and others who follow Medicare physician fee schedule policy and RBRVS updates. The article also places the review in the context of RUC participation, budget neutrality, and broader reimbursement concerns.
Why This Topic Matters
The review process can affect relative value assignments and thus future reimbursement patterns for physician services. Readers involved in coding, valuation, or practice revenue planning need to understand how CMS is prioritizing review candidates and what information may be needed when recommending services for reconsideration.
Article Sections
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Five-year review: More on CMS’s plan to choose high volume codes to be included in the next five-year review of work RVUs
Introduces CMS’s planned approach to selecting services for review and the broader policy context for work RVU revaluation.
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Site-of-service shift
Describes CMS’s interest in services whose setting of care has changed over time and how that affects the review focus.
What You Will Learn
- How CMS is approaching selection of physician services for the next five-year RVU review
- Why high-volume services and site-of-service changes are being emphasized
- How specialty groups and individual clinicians may contribute nominations for review
- What broader reimbursement and payment-system concerns are being raised in response to the review
- How the RUC and CMS fit into the RVU revaluation process
Who Should Read This
- Physicians
- Medical coders
- Coding auditors
- Practice managers
- Reimbursement specialists
- Healthcare consultants
- Medical group administrators
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