RBRVS: What Is It and How Does it Affect Pediatrics?

In today’s rapidly changing health care environment, it is crucial to understand the Medicare RBRVS physician fee schedule. Many third-party payers, including Medicaid programs, private carriers, and managed care organizations are utilizing variations of the Medicare RBRVS to determine physician payment rates.

In order for a physician to succeed in the changing marketplace, measurements of the costs involved in providing services will need to be ascertained; these costs include:

  • Physician income and benefits
  • Practice expenses
  • Professional liability insurance premiums
  • Frequency of services provided

Once this information is determined and the appropriate RVUs for each service are obtained, a physician will be able to calculate the costs involved in the provision of each service, as well as the average cost per service provided and per member per month estimates.

Download this brochure, which provides a brief background on RBRVS, gives helpful examples on how relative value units (RVUs) are calculated, and includes a table of current RVUs for commonly reported pediatric codes.

The accompanying RBRVS Conversion Spreadsheet allows you to calculate Medicare payment rates using your geographic location (download required).

Learn how RBRVS impacts how you get paid

Last Updated

09/18/2024

Source

American Academy of Pediatrics