tci General Surgery Coding Alert - 2009 Issue 11

Reader Question: Geography Affects Your Payments

Question: My physician has asked me to explain how to figure out what our reimbursement will be based on the RVUs a payer assigns to a code. He wants to know why we're getting paid differently than his colleague in another state. Can you help? Kansas Subscriber Answer: Many insurers adopt in some form Medicare's resource-based relative value scale, which assigns codes relative value units (RVUs) based on the service's work and required resources. Each code consists of RVUs that represent service work, practice expense, and professional liability. These values depend on the service's location -- nonfacility or facility...

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