When submitting claims, listing RVUs in the incorrect order might lower your reimbursement.Medicare assigns relative value units (RVUs) to each CPT CPT See: Carriage Paid To code. These values can change yearly, and if you are not attentive at·ten·tive adj. 1. Giving care or attention; watchful: attentive to detail. 2. Marked by or offering devoted and assiduous attention to the pleasure or comfort of others. , you may miss changes that might affect your reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. . Updated RVUs are published each year in the Federal Register. Although RVUs change regularly, conversion factor has remained the same for the past 2 years ($37.8975 per RVU RVU Relative value unit, see there for 2006 and 2007). Let's assume that for the past 2 years, you have been ranking RVU value codes from highest to lowest as recommended. Have you verified that the RVUs for the CPTs you bill most often have not changed? Have you made sure that you are still listing them in the correct order for maximum reimbursement? The figure illustrates a simple example of how a change in RVUs may affect the way you are reimbursed. Look at the two codes that are frequently billed conjointly con·joint adj. 1. Joined together; combined: "social order and prosperity, the conjoint aims of government" John K. Fairbank. 2. : 31255 (total endoscopic en·do·scope n. An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach. en ethmoidectomy) and 30520 (septoplasty). Then look at the changes in RVUs that have occurred since 2005. If you were billing correctly in 2005, you would have submitted code 31255 first, followed by 30520. This would have allowed you to be paid 100% of the allowable for the highest RVU procedure and 50% of the allowable for the subsequent procedure. Such reimbursement is based on the multiple-procedure reduction formula that is commonly used by most payers. However, note that the RVUs were changed in 2006 and 2007 so that the RVU for CPT 30520 is now higher than the RVU for CPT 31255. Accordingly, you should bill CPT code 30520 first and CPT code 31255 second. If not, every time you submit a claim for these two procedures, you will be receiving $52.87 less than you are entitled en·ti·tle tr.v. en·ti·tled, en·ti·tling, en·ti·tles 1. To give a name or title to. 2. To furnish with a right or claim to something: to--that is, the difference between the correctly billed $752.08 and the incorrectly billed $699.21. Can you afford to forfeit To lose to another person or to the state some privilege, right, or property due to the commission of an error, an offense, or a crime, a breach of contract, or a neglect of duty; to subject property to confiscation; or to become liable for the payment of a penalty, as the result of a that much? Steven F. Isenberg, MD Dr. Isenberg is an otolaryngologist in private practice in Indianapolis; sisenberg@good4docs.com
Figure. Chart shows the difference in payments for incorrectly and
correctly submitted claims. All figures are based on 2007 Medicare
transitional RVUs.
Payment
CPT 2005 2006 2007 of Medicare
code RVU RVU RVU allowable
31255 11.69 11.79 11.37 $430.89
30520 11.33 12.82 14.16 $536.63
Total
Payment Payment
CPT if billed if billed
code incorrectly correctly
31255 $430.89% $536.63 (100%)
30520 $268.32% $215.45% (20%)
Total $699.21 $752.08
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