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High-Risk Providers: The OIG Uses Time To Identify You

By Frank Cohen, Director of Analytics and Business Intelligence

As originally published by Racmonitor.com

Since 1992, payments to physicians for Medicare Part B have been based upon the Resource-Based Relative Value Scale (RBRVS). The RBRVS contains three specific components: the Work Relative Value Unit (RVU), the Practice Expense RVU, and the Malpractice Expense RVU. Each of these measures, relationally, focuses on the resources consumed when a medical provider performs a given service or procedure on a beneficiary.

While there is a complex process to create the individual RVU values, for the most part they rely upon a time calculation that is maintained by the Specialty Society Relative Value Scale Update Committee, or RUC for short. The RUC, which is managed by the American Medical Association (AMA), conducts research on the amount of time it takes to perform a procedure and reports its findings to the Centers for Medicare & Medicaid Services (CMS), which then uses the results to create the RVU components. While the Practice Expense RVU is influenced by this data, it is the Work RVU that is plainly based upon the RUC time estimates.

These time estimates are created based on a survey system devised by the RUC, which represents only a couple dozen of specialties via national medical specialty societies. Every five years, the RUC goes through a major review of the time estimates and CMS makes adjustments to the RBRVS based upon ongoing recommendations. The reviews are conducted via a survey that is completed by some number of physicians for each of the member specialty societies.

Read the full article on Racmonitor.com