tci Medicare Compliance & Reimbursement - 2019 Issue 7
Reader Question: Understand How Location Impacts RVUs
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Article Overview
This article explains the general structure of Medicare physician payment under the Physician Fee Schedule and why location can affect payment amounts. It is written for coders and billing professionals who want a high-level understanding of the factors CMS uses in payment calculations, along with a reference to a CMS lookup tool for estimating fee schedule amounts.
Why This Topic Matters
Understanding the components behind Medicare payment helps coding and billing staff interpret why reimbursement can vary by procedure and geography. The article provides context for fee schedule methodology without requiring readers to work through the calculation manually.
Article Sections
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Question
Introduces the reader’s question about Medicare payment methodology and the role of the conversion factor.
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Answer
Explains the main components used in the Medicare Physician Fee Schedule payment framework, including relative value concepts and geographic adjustment factors.
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Resource
Points readers to a CMS fee schedule lookup tool and mentions an additional external resource for pricing and coding support.
What You Will Learn
- How Medicare physician payment is structured at a general level
- Why geographic location can influence fee schedule amounts
- What types of factors are considered in the Medicare payment formula
- Where to find a CMS tool for estimating physician fee schedule payments
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Practice administrators
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