Understanding the Hidden Information in Resource Based Relative Value Scale (RBRVS)

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

All About RBRVS in 90 minutes!

Resource-based relative value scale (RBRVS) is a procedure that helps determine how much money medical providers should be paid. It is partially used by Medicare in the United States. Per RBRVS, a relative value is assigned to procedures performed by a physician or other medical provider, which is adjusted according to geographic region. For instance, a procedure performed in Dallas has less worth than a one performed in Manhattan.

RBRVS determines prices based on three separate factors such as physician work, practice expense and malpractice expense. Though the RBRVS became effective on January, 2014, there is still a lot to learn about this procedure for medical service providers.

In this training session, expert speaker Duane Abbey, Ph.D., will provide you answers to many important questions such as:

  • What is RBRVS?
  • Where did it come from?
  • What is the relationship between RBRVS and MPFS (Medicare Physician Fee Schedule)?
  • Do both physicians and hospitals need to know about what is in the RBRVS?
  • Does the RBRVS have anything to do with the Medicare Global Surgical Package (GSP)?
  • How does the RBRVS accommodate provider-based clinics for hospitals?
  • Does the RBRVS have anything to do with physician supervision?
  • How does the MPFS accommodate CPT codes, HCPCS codes and the various modifiers?
  • Which healthcare providers and suppliers are paid using RBRVS?
  • Are there special provisions in RBRVS for non-physician practitioners?

Areas covered in the session: 

  • Overview of RBRVS
    • Types of Health Care Payment Systems
    • Fee Schedule Payment Systems
    • Historical Development and Use of RBRVS
    • Types of Providers Covered by RBRVS
    • MPFS – Medicare Physician Fee Schedule
    • Locating and Downloading the RBRVS
  • Elements Within the RBRVS
    • RVUs
      • Facility
      • Non-Facility
    • Special Indicators for Adjudication
    • Post-Operative Periods
    • Pre-Operative and Post-Operative Payment Splits
    • Diagnostic Supervision Levels
    • Additional Information
  • Relative Values
    • Three Components for RVUs
    • Basis for Development of RVUs
    • Facility versus Non-Facility Practice Expense RVUs
  • Using RBRVS To Establish Charges
    • Developing a Professional Fee Schedule
    • Developing Chargemaster Facility charges
  • Global Surgical Package
    • Pre-Operative and Post-Operative Periods
    • Pre-Operative, Intra-Operative and Post-Operative Payments
    • Use of the “-54”, “-55” and “-56 Modifiers
    • Normal Complications and Return to Operating Room Concepts
  • Provider-Based Clinics and RBRVS
    • Freestanding versus Provider-Based
    • Place of Service and Site of Service Differential
    • Economic Advantages for Provider-Based
    • Special Situations
  • Hospital Payments Under RBRVS
    • Physical Therapy and Occupational Therapy
    • Critical Access Hospitals
    • Related Fee Schedule Concepts
  • Special Issues
    • Special Organizations
    • Physician Supervision
    • 3-Day Payment Window
    • Sustainable Growth Rate (SGR)
  • Sources for Information on RBRVS

Session objectives

  • To discuss the Resource Based Relative Value Scale (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 how RBRVS is structured and how payments are calculated
  • To understand how hospitals become involved in and can utilize the Medicare physician fee schedule (MPFS)
  • To appreciate the wealth of information contained in the RBRVS
  • To recognize how RBRVS supports the Medicare Global Surgical Package (GSP)
  • To understand the facility versus non-facility aspects of RBRVS and the relationship to hospital-based clinics
  • To appreciate how RBRVS can be used to establish professional charges for physicians and provider-based clinics
  • To appreciate that physical therapy and occupational therapy services are paid based on RBRVS
  • To understand the involvement of RBRVS with ASCs, CORFs, IDTFs, and CAHs
  • To recognize sources of information from CMS concerning RBRVS and the Federal Register updating process

Who should attend: 

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 are paid through or involved with RBRVS including CORFs, Physical/Occupational Therapy, ASCs, CAHs and IDTFs.  Hospital personnel who need to have a better understanding of the physician payment process under the Medicare program. Chargemaster coordinators, cost accounting personnel, compliance personnel, physician and clinic directors, non-physician practitioners, clinic network administrators.



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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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