decisionhealth Newsletters, Coder Pink Sheets - 2025 Issue 8 (August)
Getting paid: Investigate all three RVU amounts for accurate pay predictions
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Article Overview
This article reviews how Medicare physician fee schedule relative value units are used to estimate payment for services and why looking at work, practice expense, and malpractice components matters when comparing reimbursement across settings. It is aimed at coders, billers, and practice leaders who want to evaluate proposed annual fee schedule changes, monitor services they commonly report, and understand how CMS proposal materials can affect future revenue.
Why This Topic Matters
Annual fee schedule updates can alter expected reimbursement even when a conversion factor remains unchanged, so practices need to track RVU changes for their core services and plan comments on proposed rules when needed.
Article Sections
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Telemedicine payment comparison and RVU components
Discusses a payment comparison involving telemedicine and office/outpatient services and introduces the three RVU components used in physician fee schedule calculations.
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Check on RVU changes
Explains how to review proposed annual RVU updates in CMS rulemaking materials and why these updates matter for forecasting revenue.
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Examples of proposed payment impact
Presents example comparisons showing how changes in RVU components can affect projected reimbursement under a proposed rule.
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Comment period and resources
Notes the CMS comment deadline and points readers to supporting rulemaking resources for further review.
What You Will Learn
- How RVU components factor into payment estimation
- Why proposed physician fee schedule updates can affect reimbursement forecasts
- How to use CMS rulemaking materials to review services you report
- What kinds of payment comparisons can illustrate RVU changes over time
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Physician practices
Codes Discussed
Code Ranges Discussed
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