RBRVS
======

The Formula:
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The Resource Based Relative Value Scale (RBRVS) is intended to reimburse physicians for their services, based on the relative value of each service.  The value is based on many factors, including the time, training, overhead, skill, risk and so forth associated with a given service.

A Relative Value Unit (RVU) is the sum of three components: work, practice expense and malpractice.  These components are each multiplied by a separate Geographic Practice Cost Index (GPCI's), and the three results are summed.

That sum is then multiplied by a Conversion Factor (CF), which is currently set at $31.001 and will be updated annually.  Thus, the entire formula is:

	RVU(work)  x GPCI(work)  = _______
	RVU(pract) x GPCI(pract) = _______
	RVU(malpr) x GPCI(malpr) = _______

			     Sum = _______

				*   31.001  (the CF)	

				 = Payment

The CF will change each year, although it is the same for all physicians.  The GPCI's for work, practice expense and malpractice vary by geographical locations, and can be found in the Federal Register of 11/25/1991.  



Running the program:
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To run the program, first use the Setup command to enter the Conversion Factor and the three GPCI values.  These will be stored in a data file (RBRVS.CST), and only have to be entered once.  Of course, if the government changes the CF or GPCI's, or you move, just use Setup again.

For each service, enter the CPT code and a brief description of that service.  Next, enter the RVU's for work, practice expense and malpractice.  They are found in the Federal Register of 11/25/91, although some of the more common ones are included under Help.  When you press the Calculate button, the answers will be displayed.

To print, just press the Print button and a copy of the form displayed on screen will be sent to your printer.  Use the Windows Control Panel to select and adjust the printer.



Common RVU's:
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99201	New office visit	0.40	0.39	0.04
99202	New office visit	0.77	0.49	0.05
99203	New office visit	1.14	0.57	0.06
99204	New office visit	1.68	0.83	0.08
99205	New office visit	2.22	0.91	0.09

99211	Est office visit	0.21	0.20	0.02
99212	Est office visit	0.40	0.30	0.02
99213	Est office visit	0.58	0.39	0.03
99214	Est office visit	0.93	0.55	0.04
99215	Est office visit	1.46	0.81	0.07

99221	Initial hosp care	1.13	0.72	0.06
99222	Initial hosp care	1.84	1.10	0.09
99223	Initial hosp care	2.54	1.20	0.09

99231	Subseq hosp care	0.58	0.40	0.03
99232 	Subseq hosp care	0.93	0.48	0.04
99233	Subseq hosp care	1.26	0.64	0.05

99238	Hospital d/c day	1.14	0.56	0.04

99291	Crit care, 1st hr	2.49	1.51 	0.11
99292	Crit care, add'l 30"	1.26	0.68	0.05

99281	ED visit		0.30	0.30	0.02
99282	ED visit		0.52	0.40	0.03
99283	ED visit		0.92	0.53	0.04
99284	ED visit		1.79	0.75	0.06
99285	ED visit		2.79	1.19	0.09



Other information:
--------------------

The "fee schedule amount" is what Medicare thinks you should get paid for performing a service.  If you are a non-participating physician, the fee schedule amount is only 95% of that.  If you are in a Health Professional Shortage Area, you are eligible for a 10% bonus payment.  Fresh out of residency?  Guess what:  according to the government you're only 80% as good as a doctor whose been around for 5 years or more:

		New physicians:
		================
	Year #1		80% of fee schedule
	Year #2		85% of fee schedule
	Year #3		90% of fee schedule
	Year #4		95% of fee schedule
	Year #5		100% of fee schedule

The only exception is physicians in a designated Health Professional Shortage Area, who will not be subject to the above penalties, and still qualify for the 10% bonus.

Physician Assistants are allowed 65% of the physician fee schedule when assisting at surgery, 75% for other in-hospital services, and 85% for all other services.

Nurse practitioners are limited to 85% of the fee schedules, unless the services are rendered in a rural area hospital, in which case it is only 75% (don't ask me why...).

Nurse midwives are limited to 65% of the fee schedule.
	


Registration:
----------------

Questions?  Contact me at 74040.3157 on CompuServe, or DWTX17A on the Prodigy service.  

This is FairWare, with a recommended registration fee of $10.  However, if you think it's worth $5, send me $5.  If you think it's worth $15, send $15.  If you think it's worth $1500, send $1500 (*grin*)!  Be fair, though, and register the software if you find it useful.  

Thanks!!


Author:	Mark Ebell MD
-------	Doggone Software Ltd.
	310 Snapfinger Drive
	Athens, GA  30605

	