ED Coder Roles Broaden With Reduction in RVU Values for Emergency E/M Levels
Published on Sat May 01, 1999
by Caral Edelberg, CPC
Consulting Editor
In many of todays EDs, hospital medical records departments, and group practice business offices, staffing for coding and billing functions is limited. In many cases, coders have been designated the coordinators of the entire reimbursement process. As a result, many emergency medicine coders have been forced to expand their roles and must now familiarize themselves with payment principles that in the past were the domain of practice managers.
Coders have been forced to become increasingly aware of principles outside the normal boundaries of coding, particularly in terms of recognizing the elements of code assignment that have the potential for impact on emergency medicine revenue. This months column will discuss one such element: Medicares 1999 Resource-Based Relative Value Scale (RBRVS), which introduces new complex practice-expense calculations based on the site of service.
The new method Medicare is instituting to calculate the practice-expense component will have a significant impact on emergency medicine reimbursement, and emergency coders, in particular, must take the initiative to keep their physician group or groups aware of the potential loss in revenue over the four-year phase-in period.
What is RBRVS?
For those new to professional coding, RBRVS forms the basis of payment to physicians for services provided to Medicare beneficiaries. Because it is considered the most sophisticated payment system available, many private payers have also adopted the RBRVS methodology to determine their payments to providers. Thus, RBRVS methodology is fast becoming the means by which many providers services are paid. Using this system, the various HCPCS codes (which include CPT-4 and ICD-9 codes) are assigned relative value units (RVUs). The number of units is multiplied by a dollar-value conversion factor to determine the amount of payment for the service.
In order to calculate the number of RVUs assigned for a particular service, Medicare RBRVS uses a complex formula to consider and assign values to the various components of physician resources that are used to provide medical care. These components are: location of the practice, expenses of the physician to maintain the practice, and the overall complexity of the care that is rendered.
BBA Changes Emergency Physician
Practice-Expense RVUs
The Balanced Budget Act of 1997 (BBA) required a four-year transition from a charge-based practice-expense methodology to a resource-based methodology. The first phase of this transition became effective in January 1999. As part of this transition, Medicare began revising the practice-expense RVU component to focus resources more heavily on office-based practices and less on surgical-intensive specialty practices and facility-based practices. The result is a reduction in the practice-expense component for the specialty of emergency medicine. Although significant controversies exist over how this resource-based practice expense was determined, the transition nevertheless became effective this year.
One means of estimating the effect on [...]
