RVU help?

[finalpsychyear]

I need some help. It is my understanding that rvu are set by CMS. A 99213 is 0.97, 99214 is 1.5, 90833 is 1.5.

I was told that hospitals can change the value of this set amount but it was my understanding that they can only change the dollar amt per RVU. For example I think mgma for psych is something like very close to 64 per 1.0 rvu so im sure some hopsitals would offer less but they cannot change a 99213 being 0.97 rvu. Is my understanding correct or can a hospital make a 99213 great or less than 0.97 rvu?

Thanks to whoever can help.

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[st2205]

I need some help. It is my understanding that rvu are set by CMS. A 99213 is 0.97, 99214 is 1.5, 90833 is 1.5.

I was told that hospitals can change the value of this set amount but it was my understanding that they can only change the dollar amt per RVU. For example I think mgma for psych is something like very close to 64 per 1.0 rvu so im sure some hopsitals would offer less but they cannot change a 99213 being 0.97 rvu. Is my understanding correct or can a hospital make a 99213 great or less than 0.97 rvu?

Thanks to whoever can help.

They can change it based on how they're reimbursing you and not what they actually get. As it's all internal they can set it wherever they want but it has no bearing outside the system. Similar to if the government was paying people for apple picking at $0.15/pop. Someone could come along and say "I'll pay you $0.18/pop" and it won't change what the government pays. In fact, they will just sell them back to the government at $0.15/pop but the government will also give them another $0.15 to compensate for the fact that they had to use their own orchard to pick from, so it's a win-win-win (sort of).

 

[finalpsychyear]

They can change it based on how they're reimbursing you and not what they actually get. As it's all internal they can set it wherever they want but it has no bearing outside the system. Similar to if the government was paying people for apple picking at $0.15/pop. Someone could come along and say "I'll pay you $0.18/pop" and it won't change what the government pays. In fact, they will just sell them back to the government at $0.15/pop but the government will also give them another $0.15 to compensate for the fact that they had to use their own orchard to pick from, so it's a win-win-win (sort of).

Thanks. Are you certain about this? I am pretty sure a 99213 is the equivalent of 0.97 rvu and a 90833 is 1.5 rvu based on 2016/2017 data. What any hospital pays per RVU varies as you said but those set values (0.97, 1.5) are set by CMS every year and do fluctuate per year depending on what CMS decides.

 

[st2205]

Not as far as CMS and insurance but nothing's stopping the system from arbitrarily determining their own values for each CPT code. That's kind of laborious, though, and much easier to adjust the dollar amount.

FWIW I've never heard of a system changing the value of them (the value of RVUs for each code). Again they can't change the value of them when they submit them to insurance but they could change it for how they pay their physicians.

 

[hamstergang]

Is there a specific reason you're asking this question?

 

[Shikima]

The only RVUs you can change are what each RVU is worth and the total amount you collect before it jumps to a "bonus" system.

 

[trophyhusband]

I need some help. It is my understanding that rvu are set by CMS. A 99213 is 0.97, 99214 is 1.5, 90833 is 1.5.

I was told that hospitals can change the value of this set amount but it was my understanding that they can only change the dollar amt per RVU. For example I think mgma for psych is something like very close to 64 per 1.0 rvu so im sure some hopsitals would offer less but they cannot change a 99213 being 0.97 rvu. Is my understanding correct or can a hospital make a 99213 great or less than 0.97 rvu?

Thanks to whoever can help.

So theoretically can they set the RVU higher or lower? Yes, I believe they can. Would they ever do it? No, unless they really enjoy compliance nightmares.

So from the perspective of a hospital system's financial auditors you'd want one variable to be constant. In this case either the $ value per RVU needs to be constant for all physicians or the RVU value by CPT/HCPCS/whatever. Since RVU values are set by CMS for Medicare/Medicaid it's easier to just maintain that value as the constant and negotiate the $ per. If they were to allow both to be adjusted there would be issues with correctly identifying which physician gets what and then you have the yearly financial audit to worry about where the auditors need to be able to recalculate the compensation for hundreds or thousands of physicians at a time. They have to look at the contracts for each one to verify the $ per RVU they're getting but if they have to manually input the RVU value rather than just use the values that can be pulled from the CMS website with relative ease the financial audit would never end (and who knows how many errors they would find).

That's the practical reason why it wouldn't happen. I wouldn't be surprised if someone somewhere was doing it but I can't even imagine how painful that process must be and how many compliance issues they must have with it.

 

[Shikima]

It's all negotiated in the contract. Once the contract is up, renegotiation of RVUs is important.

 

[finalpsychyear]

Is there a specific reason you're asking this question?

It's all negotiated in the contract. Once the contract is up, renegotiation of RVUs is important.

The reason I am asking is because I am negotiating with a hospital system and they offer a guarantee or RVU system to calculate your salary whichever is higher.
So if a hospital system is agreeable to pay 64.00 per RVU then seeing a patient for a 99213+90833 would equal roughly 2.47 RVU of work which means the hospital would
pay 64 x 2.47 = 158.00 for the encounter regardless of insurance?

Is this a fair rvu (64.00) for psych using the mgma book standards as I have no idea otherwise.

 

[st2205]

The reason I am asking is because I am negotiating with a hospital system and they offer a guarantee or RVU system to calculate your salary whichever is higher.
So if a hospital system is agreeable to pay 64.00 per RVU then seeing a patient for a 99213+90833 would equal roughly 2.47 RVU of work which means the hospital would
pay 64 x 2.47 = 158.00 for the encounter regardless of insurance?

Is this a fair rvu (64.00) for psych using the mgma book standards as I have no idea otherwise.

Yes, I think it's fair. Run the numbers. Also, if you're worried that they'll be able to pull the fast one by manipulating the CPT code values then o really wouldn't worry about that.

 

[nexus73]

The reason I am asking is because I am negotiating with a hospital system and they offer a guarantee or RVU system to calculate your salary whichever is higher.
So if a hospital system is agreeable to pay 64.00 per RVU then seeing a patient for a 99213+90833 would equal roughly 2.47 RVU of work which means the hospital would
pay 64 x 2.47 = 158.00 for the encounter regardless of insurance?

Is this a fair rvu (64.00) for psych using the mgma book standards as I have no idea otherwise.

I get around $64 per RVU

 

[finalpsychyear]

I get around $64 per RVU

Thanks. I appreciate your input. In rvu terms, 99213 = 0.97, 99214 = 1.5, 90833 = 1.5 in your neck of the woods as well?

 

[splik]

srsly, this is not a "neck of the woods thing." This is set by the AMA CPT committee (don't get me started on that. talk about foxes guarding the chicken coop).

 

[finalpsychyear]

srsly, this is not a "neck of the woods thing." This is set by the AMA CPT committee (don't get me started on that. talk about foxes guarding the chicken coop).

This is what I always thought but some posts have made me confused. Thanks for confirming this!

 

[splik]

This is what I always thought but some posts have made me confused. Thanks for confirming this!

not to confuse you further, I am simplifying a little. technically there is a difference in medicare reimbursement depending on geography. More expensive locales pay more. There is something caled the GPCI (geographic practice cost index). This is supposed to take account for this but in practice it makes so little difference it not worth considering.

Also maybe what was confusing is there is wide differences in what the conversion factor (i.e. the dollar amount for the RVU) is - varies between insurance companies and thus varies wildly between geographic area. But this is distinct of course from the actual RVUs assigned to a CPT code.

 

[finalpsychyear]

not to confuse you further, I am simplifying a little. technically there is a difference in medicare reimbursement depending on geography. More expensive locales pay more. There is something caled the GPCI (geographic practice cost index). This is supposed to take account for this but in practice it makes so little difference it not worth considering.

Also maybe what was confusing is there is wide differences in what the conversion factor (i.e. the dollar amount for the RVU) is - varies between insurance companies and thus varies wildly between geographic area. But this is distinct of course from the actual RVUs assigned to a CPT code.

Thanks for the clarification. So a 99213 being worth 0.97, 99214 = 1.5, 90833 = 1.5 are universal standards so this is not something i need to ask my hospital about since i know they are offering 64.00 roughly per rvu which seems fair according to other posts. Good to know.

Thanks again.

 

[michaelrack]

Maybe your hospital is differentiating between work rvu and total rvu