Catalog Number : cbpa1101
Title : Basic RBRVS: Resource Based Relative Value System
Speaker : Duane Abbey

Webplay Recording Date : 3-31-06
Webplay Price : $ 225 for two weeks viewing

Webinar Presenter: Duane C. Abbey, Ph.D., CFP

Webinar Title: Basic RBRVS - Medicare’s Physician Payment System

Webinar Level: Basic

Webinar Overview - General

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

In the RBRVS system, payments for services are determined by the resource costs needed to provide them. The cost of providing each service is divided into three components: physician work, practice expense and professional liability insurance. Payments are calculated by multiplying the combined costs of a service by a conversion factor (a monetary amount that is determined by the Centers for Medicare and Medicaid Services). The physician work relative values are updated each year to account for changes in medical practice Payments are also adjusted for geographical differences in resource costs.

Learning Objectives Include:

• To discuss the Resource Based Relative Value System (RBRVS) which provides the basis for the Medicare Physician Fee Schedule (MPFS)
• To appreciate RBRVS as a fee schedule health care payment system
• To appreciate the global surgical package (GSP) concept and associated payment processes
• To understand the three basic components of RBRVS
• To have reviewed simple examples of how RBRVS payment is calculated
• To appreciate the differences in RBRVS payment for facility versus non-facility payment
• To understand RBRVS as a complex fee-schedule payment system.

The following are only a few of the topics to be discussed:

I. Overview of RBRVS
   a. Types of Health Care Payment Systems
   b. Fee Schedule Payment Systems
   c. Historical Development and Use of RBRVS
   d. Types of Providers Covered by RBRVS
   e. MPFS - Medicare Physician Fee Schedule
II. Relative Values
   a. Three Components for RVUs
      i. Work Effort
      ii. Overhead Expense
      iii. Medical Malpractice
   b. Basis for Development of RVUs
III. Calculation of RBRVS Payment
   a. Conversion Factor
   b. Geographical Adjustments
   c. Special Adjudication Rules
   d. Global Surgical Package
IV. Sample Calculations for Services
V. Special Issues
   a. Facility versus Non-Facility
   b. E/M Coding c. Medicare’s Correct Coding Initiative Edits

Prerequisites for Participating: Attendance of ‘Introduction to Health Care Payment Systems’ or equivalent.

Suggested Attendees: All hospital or clinic personnel involved with physician coding, billing and claims filing. Hospital personnel involved with provider-based clinics and establishing physician fee schedules. All hospital personnel involved with hospital services that paid through or involved with RBRVS including CORFs, Physical/Occupational Therapy, ASCs, CAHs. All hospital personnel who need to have a better understanding of the physician payment process under the Medicare program.

Attendance Certificate: Upon attending this course you will receive a 2 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.