1. What Are RVUs?
Dr. Daria Starosta
Edward Conway, CPA

2. What is an RVU? Relative Value Unit
Part of a CMS system - RBRVS (Resource Based Relative Value Scale)
Each CPT Code is assigned an RVU
3 Components - per procedure:
$$ for amount of work involved
$$ for amount of risk involved
$$ for amount of overhead

3. RVU Values
RULE OF THUMB: The higher the Risk of the patient’s presenting problem and the work involved to treat and stabilize, the higher the value of RVUs assigned, i.e. Pt presents in Cardiac Arrest, requires Intubation (3.03), Monitor (.22) and EKG (.25) interps done by provider, and CCT 30min requested (5.99) = 9.49 RVUs
Exception to this rule are RVU Values assigned to some Orthopedic procedures and codes.
Code
RVUs
Description
23650
6.91
Reduce Closed Shoulder Dislocation
24650
5.75
Treat Radius Fracture
24670
6.39
Treat Ulnar Fracture
26600
6.49
Treat Metacarpal Fracture
26641
8.41
Treat Thumb Dislocation
26720
4.38
Treat Finger Fracture
26770
6.20
Treat Finger Dislocation

4. CPT to RVU Translation CPT DESCRIPTION RVU Value 99281 99282 99283
99284
99285
99291
99292
93010
93042
12001
DESCRIPTION
Level 1
Level 2
Level 3
Level 4
Level 5
Critical Care 1st Hour
Crit. Care Add’l. 30 mins.
EKG Interpretation
Rhythm Strip Interp.
Simple repair <2.5 cm
RVU Value
0.58
1.12
1.71
3.21
4.74
5.99
2.99
0.25
0.22
2.76

5. Where can I find an RVU? Federal Register and CMS Websites
Other guides also publish each year
Subject to Periodical adjustment by CMS
RVUs can’t be changed by billing companies, insurance companies, doctors or patients

6. RVU Compensation RVUs are generated based on billable codes.
When RTI Coders assign billable codes to patients, RVUs associated with those codes are generated.
RVUs are combined for all procedures billed to a patient.

7. How does Payroll calculate RVU Pay?
Payroll runs a report from RTI’s billing system with all the Patients and associated RVUs coded to each provider at a site in a Fiscal Period (or month).
That information is then calculated in a spreadsheet with the RVU $ value, which is established by the Finance Dept. at EmCare.

8. How will RVU-based pay align incentives?
Encourages physicians to see as many patients as possible
Encourages appropriate documentation
Physician who documents well will be paid accordingly.
Employer should be able to collect appropriate amounts for services provided

9. Sample RVU Productivity Report
January - July 2013
Statistics
Provider
# hrs worked
# pts seen
# rvus
RVU Value
RVU payment
avg per hr worked
avg # pts/hr
avg # rvus/pt
avg # rvus/hr
Provider 1
1,542.00
3,514
14,749.04 $
$ 81,120 $
2.28
4.20
9.56
Provider 2
767.75
1,791
7,129.31
$ 39,211 $
2.33
3.98
9.29
Provider 3
567.75
1,314
5,131.96
$ 28,226 $
2.31
3.91
9.04
Provider 4
905.25
2,152
7,458.77
$ 41,023 $
2.38
3.47
8.24
Provider 5
229.00
489
1,878.63
$ 10,332 $
2.14
3.84
8.20
Provider 6
1,108.00
2,203
8,890.06
$ 48,895 $
1.99
4.04
8.02
Provider 7
124.00
271
985.94
$ ,423 $
2.19
3.64
7.95
Provider 8
602.50
1,131
4,692.07
$ 25,806 $
1.88
4.15
7.79
Provider 9
136.00
275
1,050.57
$ ,778 $
2.02
3.82
7.72
Provider 10
888.00
1,825
6,769.96
$ 37,235 $
2.06
3.71
7.62
Provider 11
429.00
738
3,178.76
$ 17,483 $
1.72
4.31
7.41
Provider 12
28.25 57
202.63
$ ,114 $
3.55
7.17
Provider 13
237.00
410
1,672.35
$ ,198 $
1.73
4.08
7.06
Provider 14
201.00
351
1,266.00
$ ,963 $
1.75
3.61
6.30
Provider 15
157.50
270
955.05
$ ,253 $
1.71
3.54
6.06
Provider 16
135.00
217
787.73
$ ,333 $
1.61
3.63
5.84
Provider 17
59.50 69
261.66
$ ,439 $
1.16
3.79
4.40
2013 YTD
8,286.50
17,510
68,887.45
$ 378,881 $
2.11
3.93
8.31

10. Statistics Explanation
Patients / Hour – represents productivity of each provider.
RVUs / Patient – indicate the acuity of the patients, as well as the documentation of each chart and patient.
RVUs / Hour – represents the productivity and documentation of each physician.

11. What is the expected outcome?
Improved documentation and productivity =
RVU value increase (per patient) at hospital
Physician compensation increase

12. Are there other benefits to this besides aligning incentives?
May cause physicians to pay more attention to and address patient flow/slow areas
Lab
X-ray
Better documentation improves QA procedures and analysis
Should improve patient satisfaction and volumes
Reduces risk of losing malpractice cases
Better measures of productivity

13. Will this system encourage up-coding?
NO!!
Coding guidelines are subject to medical necessity
Appropriate checks and balances

14. Core Components of Program
Providers will only document services that they actually provided
If a provider is documenting an incomplete record, he/she will only document services or procedures that can be independently recalled or ascertained from the entire record.
All addendums must be made on the original record (unless authorized otherwise by your hospital’s HIM department) and must be initialed and dated.

15. Billing Guidelines
Physicians and other practitioners should only submit bills for services rendered that are medically necessary
Physicians and other practitioners should not “knowingly or willfully”
Bill for services not actually provided
Misrepresent services that were not provided
Make false statements to government agencies about EmCare’s compliance with any Federal or state rules
Falsely certify that services were medically necessary

16. Billing Guidelines
The patient’s medical record should accurately reflect all services and items furnished to a patient and should also provide support for the medical necessity of the service or item
If a service or item is provided to a patient that was not ordered by the physician, it should not be billed to the patient
In no case should you indicate that a service or item is medically necessary unless it is supported by the patient’s medical record.

17. Questions??
Thank you!!