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2 Evolution of MHS RVUs Development of MHS RVUsDevelopment of MHS RVUs System Specific RVUsSystem Specific RVUs Future of MHS RVUsFuture of MHS RVUs QuestionsQuestions.

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Presentation on theme: "2 Evolution of MHS RVUs Development of MHS RVUsDevelopment of MHS RVUs System Specific RVUsSystem Specific RVUs Future of MHS RVUsFuture of MHS RVUs QuestionsQuestions."— Presentation transcript:

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2 2 Evolution of MHS RVUs Development of MHS RVUsDevelopment of MHS RVUs System Specific RVUsSystem Specific RVUs Future of MHS RVUsFuture of MHS RVUs QuestionsQuestions

3 3 Development of MHS RVUs Centers for Medicare & Medicaid Services (CMS) INGENIX MHS Adjustments

4 4 CMS

5 5 INGENIX

6 6 MHS Adjustments High Frequency Ingenix Zero Weighted Codes Global Maternity Global Surgery Obsolete CPT Codes Modifiers

7 7 High Freq Ingenix Zero Weighted Codes Top 85% SADR reported CPT codes with an INGENIX RVU of 0, excluding and ancillary. Provider Work Specific Procedures Groups/Families of CPT Codes Timed Procedures

8 8 Provider Work Telcons (99371, 99372, 99373) Work Related Disability Exam by Treating Physician (99455) Administration of Flu Vaccine (G0008)

9 9 Specific Procedures Follow up to Surgery (99024) LASIK/PRK (S0800/S0810) Prenatal and Postpartum Care Visits (0500F-0503F)

10 10 Global Maternity

11 11 Global Surgery Global Surgical Adjustment SADR Coding

12 12 Modifiers DOD Modifiers 00 Base Modifier 21Prolonged E&M Service 22 Unusual Procedural Service 26 Professional Component 32 Technical Component 50 Bilateral Procedures 51 Multiple Procedures 90 External Laboratory 99 Multiple Modifiers INGENIX Modifiers (None) Base Modifier 26 Professional Component 53 Discontinued Procedure NU New Durable Medical Equipment RR Rented Durable Medical Equipment UE Used Durable Medical Equipment TC Technical Component

13 13 DOD Radiology Modifiers - 21 Prolonged E&M Service Professional Component * Unusual Procedural Service Professional Component + (Technical Component * 2) -50 Bilateral Procedures (Professional Component * 2) + (Technical Component * 2) -51 Multiple Procedures Technical Component * Multiple Modifiers (Professional Component * 2) + (Technical Component * 4)

14 14 System Specific RVUs MHS Data Repository (MDR)/M2 –Direct Care (SADR) –Purchased Care (Non-institutional HCSRs) –Ancillary EAS IV CHCS

15 15 Direct Care – SADR RVUs Simple Adjusted PPS Work PPS Facility Individual Work Organizational Work Provider Work RVU

16 16 Relative Value Units (RVUs) in the MDR and M2 Name Weight Column Discounting Global Surgical Reduction Multiple Providers Provider Filter Provider Scaling CommentsCommon Application SimpleWorkNoYesNo This is the only RVU field in claims, and is also in MTF data. Comparing claims to direct care. Used by some metric systems. AdjustedWork50%No Older value retained to allow trending to early years. Individual Work Work50%, E&M YesNoYesNoFY03 on Best measure for individual productivity metrics. Organizational Work Work50%, E&M Yes NoFY03 on Best measure for work center and above productivity metrics. PPS WorkWorkE&MYes NoFY03 on Measures non-institutional burden (professional services). PPS FacilityNon- facility Practice Expense E&MYesNoYesNoFY03 on Measures institutional burden excluding the provider. Provider Work RVU Work50%No Yes FY04 and before (In MDR for FY05) Older value retained to allow trending to early years.

17 17 Purchased Care - HCSRNI Work RVUs No Global Maternity Adjustment No Global Surgery Adjustment No RVUs for 99024, 0500F-0503F INGENIX Modifiers

18 18 CHCS and EAS IV CHCS MHS Adjusted RVUs DOD Modifiers Work RVU EAS IV Same initial construction as CHCS except, Composite RVU = Work RVU + Non-Facility Practice Expense RVU

19 19 Future of MHS RVUs

20 20 Master RVU Table

21 21 EAS IV Repository Class 17 Raw statistical amount = number of procedures Weighted statistical amount = number of procedures multiplied by the RVU weight Recommended that Class 17 be used in conjunction with Class 25 Ambulatory CPT Workload

22 22 EAS IV Repository Class 25 All records whether completed or not are fed through to EAS. Class 25 contains a completion percentage that can be applied to adjust the dollars to the workload. Ambulatory Summary (NO CPT)

23 23 EAS IV Repository Class 18 Raw statistical amount = number of procedures Weighted statistical amount = number of procedures multiplied by the RVU weight Contains modifiers other than 00. Ancillary CPT Workload

24 24 Questions?


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