Part B Insider - 2015 Issue 8
RVUs Refresher: Keep Up On PFS by Building a Comprehensive Understanding of RVUs
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Article Overview
This article explains the broad framework Medicare uses to pay physician services under the Physician Fee Schedule. It covers the main components that influence payment, including relative value units, conversion factors, budget neutrality, and geographic practice cost indices, along with general examples drawn from procedural coding. The piece is aimed at coders, billers, and others who need a refresher on how payment methodology is organized and why locality matters.
Why This Topic Matters
Understanding the Physician Fee Schedule is important for anyone who works with Medicare physician reimbursement because payment depends on multiple interacting factors rather than a single code lookup. The article helps readers see how national and geographic adjustments affect reimbursement at a high level.
Article Sections
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Payment components under the Physician Fee Schedule
Introduces the basic structure Medicare uses to pay physician services and the role of procedure coding in that framework.
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Relative Value Units and service examples
Describes the inputs that make up RVUs and shows broad examples of procedural services used to illustrate the concept.
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Conversion factors and budget neutrality
Explains how conversion factors are used in payment calculation and discusses the annual update process and budget neutrality concept.
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Geographical implications on RVUs
Covers geographic practice cost indices, locality variation, and how geographic adjustments relate to payment across different areas.
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Calculating Medicare physician payment
Summarizes how the payment components are combined in the overall payment methodology.
What You Will Learn
- The major elements that make up Medicare physician payment under the PFS
- How RVUs fit into the broader reimbursement framework
- Why conversion factors and budget neutrality are part of the payment process
- How geographic adjustments are used to account for locality differences
- How the article frames the relationship among payment components
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle professionals
- Physician practice administrators
- Healthcare reimbursement staff
Codes Discussed
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