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Fix My Practice - Blog

Streamlining Your RVU Calculations

Relative Value Units (RVU) are part of the reimbursement formula, designed to measure the value of services provided by physicians. In hospitals, health systems or large group practices, a physician’s salary is often calculated on the number of RVUs provided. But independent physicians should pay careful attention to RVUs too – because RVU data can help you to set competitive prices, negotiate payer contracts, accurately predict payments, grow your practice, and evaluate mergers and acquisition opportunities.

Historically, Medicare paid physicians based on “usual, customary and reasonable” pricing. This meant that doctors nearly charged whatever they liked, and Medicare paid a percentage. Many argued that the result was procedures tending to be overpriced, while consulting, preventative and management services tended to be underpriced.

For example, a doctor making a complicated diagnosis might have been paid $40, while another doing a routine colonoscopy was paid $600. Procedural costs remained high even as technology reduced actual work times by 75% or more in many cases. As a result, insurance companies lobbied for changes and that is how RVU’s came about.

Three components make up what is known as the Total RVU, each adjusted by the Centers for Medicare & Medicaid Services (CMS) according to your geographic location.

Physician Work RVU evaluates the time and clinical skill necessary to treat a patient during a specific encounter. It usually runs about 52% of the total RVU.

Practice Expense RVU calculates the costs of labor, building space, equipment and office supplies. It typically comprises 44% of the total.

Professional Liability Insurance Expense RVU documents the cost of malpractice insurance premiums. It represents about 4% of the total.

Total RVU is simply the sum of these three component RVUs value which are added together. This number is multiplied by the Geographic Pricing Index (GPCI) to account for location. That result is then multiplied by a conversion factor (CF) that changes every year and is published by CMS to get a final dollar amount.

Calculating payments using RVUs can seem like a daunting task, but it’s not difficult if you’re prepared. Look up the current RVUs for the procedure in question as well as the year’s exchange rate and use the prescribed formulas. There are also calculators that can help, and all calculations can be validated on the CMS site.

Calculating RVUs is easier with the proper formula and values to put into it.

Values

  • PW: Physician Work
  • GPCI: Geographic Pricing Index
  • PE: Practice Expenses
  • PLI: Practice Liability Insurance
  • CF: Conversion Factor
  • PP: Physician Payment

 Formulas

  • For in-facility procedures: (PW x PW GPCI + PE x PE GPCI + PLI x PLI GPCI) x CF = PP
  • To calculate out-of-facility amounts: (PW x PW GPCI + Transitioned Non-Facility PE x PE GPCI + PLI x PLI GPCI) x CF = Out-of-Facility P

Doing a similar exercise for Code 99214 would result in a Total RVU of 5.10930. Note that this is quite a bit larger than the Total RVU for Code 99213, which makes sense. A moderate level of medical decision making (30-39 minutes) service should be valued higher than a low level of decision making (20-29 minutes).

There are other things to consider when you calculate RVUs:

  • Remember that the fee you come up with may not be the exact amount of money a physician earns. Bilateral or multiple procedure payment rules could change the final payment.
  • RVUs, conversion factors, and other parts of the process change from year to year. Stay up to date to get the most accurate numbers.
  • Using a tool to calculate RVUs for you can make the process easier.

It’s important to develop a standard process for billing and paying staff. RVUs are only one method of doing this but provide many advantages over their alternatives.

We recommend that administrator and physicians focus on calculating RVUs for their 10 most frequently used codes. Total RVUs can then be used to approximate your practice’s performance and compare it against other benchmarks nationally.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

The COVID-19 Vaccine

As members of the healthcare profession, we should ALL do our part to educate friends, family and coworkers on the safety of the vaccine and importance of being vaccinated and model trust by being vaccinated as soon as we are eligible! The technology behind the Moderna and Pfizer vaccine was developed by an African-American researcher, Kizzmekia Corbett.

It is not a live virus, only genetic information to trigger the body’s immune system, so the expected effects (site pain, fatigue, fever) are the body’s immune system waking up–and those are good signs. The genetic information does not interact with or change the body’s cells and so is safe for pregnant and lactating women. The vaccine is a two-dose regimen, and full efficacy (95%) is not achieved until about 2 weeks after the 2nd dose. The vaccine protects against symptomatic infection, but the virus can still enter the nose and mouth and be spread to others, so mask-wearing and social distancing are still required after vaccine administration.

There is a 4-phase rollout of vaccine availability, and Georgia is still in Phase 1a (high risk healthcare, law enforcement, care facilities, and age 65+). In February, Georgia will roll out a single-site registration process, consolidating existing registration through individual providers and public health departments. This is good news, since West Virginia has a single website to register for the vaccine and ranks 2nd in COVID vaccine administration, by contrast Georgia ranks 33rd among the 50 states tracked for COVID vaccine administration.

Getting the Covid-19 Vaccine for healthcare providers in Georgia

COVID-19 Vaccine

How do provider and their staff get the vaccine if they are independent and not connect to one of the hospital systems?

GA Provider COVID-19 Vaccine Registration

The first vaccination phase includes but is not limited to healthcare personnel likely to be exposed to or treat people with COVID-19, first responders, people at risk for severe illness and other essential workers. If you are linked to a hospital it’s an easy process to get your vaccine.

But what if you aren’t link to a hospital?

Healthcare Providers/Practices NOT enrolled as a COVID-19 vaccine provider or affiliated with a hospital can request to receive COVID-19 vaccination at your local public health department for themselves and their staff.

Each provider and staff member can get the vaccine now by enrolling their office at: https://dph.georgia.gov/provider-vaccine-registration-ph-district-list

There are multiple counties listed each one having a different registration process and link. https://dph.georgia.gov/document/document/provider-vaccine-registration-district-contact-list/download

Additionally, if you would like to be a COVID-19 vaccine provider you can enroll at: https://dph.georgia.gov/covid-vaccine-information-providers

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group® | www.ppsosgroup.com

Ransomware Assault Threatens Hospitals

Cyber Security in Healthcare

Recently the FBI is warning there is a new threat of ransomware attacking the US Health Systems. The ransomware assault threatens hospitals and will most likely spread to the ambulatory practices. The FBI and two other federal agencies issued a joined alert stating that this malicious attack will lead to data theft and disruption of the healthcare system and services.
According to an article in www.dailymail.co.uk
The FBI is investigating the recent attacks, which include incidents in Oregon, California and New York made public just this week, according to three cybersecurity consultants familiar with the matter.
A doctor at one hospital told Reuters that the facility was functioning on paper after an attack and unable to transfer patients because the nearest alternative was an hour away. The doctor declined to be named because staff were not authorized to speak with reporters.
‘We can still watch vitals and getting imaging done, but all results are being communicated via paper only,’ the doctor said. Staff could see historic records but not update those files.
Experts said the likely group behind the attacks was known as Wizard Spider or UNC 1878. They warned that such attacks can disrupt hospital operations and lead to loss of life.
The attacks coincide with the U.S. presidential election, but do not appear to have any connection to it.
‘We are experiencing the most significant cyber security threat we´ve ever seen in the United States,’ Charles Carmakal, chief technical officer of the cybersecurity firm Mandiant, said in a statement.
He’s concerned that the group may deploy malware to hundreds of hospitals over the next few weeks.
Alex Holden, CEO of Hold Security, which has been closely tracking the ransomware in question for more than a year, agreed that the unfolding offensive is unprecedented in magnitude for the U.S. Administrative problems caused by ransomware, which scrambles data into gibberish that can only be unlocked with software keys provided once targets pay up, could further stress hospitals burdened by a nationwide spike in COVID-19 cases.
The Russian-speaking cybercriminals suspected of the attacks use a strain of ransomware known as Ryuk, which is seeded through a network of zombie computers called Trickbot that Microsoft began trying to counter earlier in October.
In the past, ransomware infections at hospitals have downed patient record-keeping databases, which critically store up-to-date medical information, affecting hospitals’ ability to provide healthcare.
While the company has had considerable success knocking Trickbot command-and-control servers offline through legal action, analysts say criminals have still been finding ways to spread Ryuk.
The US has seen a plague of ransomware over the past 18 months or so.
In September, a ransomware attack took down all 250 US facilities of the hospital chain Universal Health Services, forcing doctors and nurses to rely on paper and pencil for record-keeping and slowing lab work.
Employees described chaotic conditions impeding patient care. Also in September, the first known fatality related to ransomware occurred in Duesseldorf, Germany, when an IT system failure forced a critically ill patient to be routed to a hospital in another city.
Holden said he alerted federal law enforcement after monitoring infection attempts at a number of hospitals, some of which may have beaten back infections.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that providers face daily. The Physicians Practice S.O.S. Group is committed to helping healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com
#ReginaMixonBates #practicemanagementconsulting #practicemanagement #physicianconsulting #medicalconsulting #businesscoach #publicspeaker #motivationalspeaker

 
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