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H458 Application Exercise 5 – Physician Services Physician Payments: Relative Value Units Last week we learned...

H458 Application Exercise 5 – Physician Services

Physician Payments: Relative Value Units

Last week we learned the calculation of payments for physician services.P

RVU Information

2012: Code 44389 Work 3.13; PE (Non Facility) 8.4; PE (Facility) 1.91; MP 0.49

Code 58800 Work 4.66; PE (Non Facility) 4.12; PE (Facility) 3.56; MP 0.79

Code 13100 Work 3.17; PE (Non Facility) 5.56; PE (Facility) 3.28; MP 0.50

Conversion Factor $34.0376

GPCI Information.

2012: Work GPCI: 0.998 PE GPCI: 0.981 MP GPCI: 0.619

Code	Description	Work RVU	Work GPCI	PE RVU	PE GPCI	MP RVU	MP GPCI	FAC TOTAL RVU	Total Payment
*2012*	*Conversion Factor $34.0376*
44389	Colonoscopy with bioposy –Non Facility
44389	Colonoscopy with bioposy – in Facility
58800	Ovarian Cyst – Non Facility
58800	Ovarian Cyst – Facility
13100	Wound Repair – Non Facility
13100	Wound Repair - Facility

Expert Solution

a

.(Work RVU*Work GPCI)+(Practice Expense RVU*Practice ExpenseGPCI)+(Malpractice RVU*Malpractice GPCI)=Total RVU

Total RVU*Conversion factor=Medicare allowable payments

Work RVU=3.13,WG PCI=0.998,PE RVU=8.43,PE GPCI=0.981,MP RVU=0.49,MP GPCI=0.619

Based on the formula(3.13*0.998)+(8.43*0.981)+(0.49*0.619)

3.12374+8.26983+0.30331=11.69688

11.69688*conversion factor=11.69688*34.0376=398.134

b .

W RVU=3.13,WGPCI=0.998,PE RVU=1.91,PE GPCI=0.981,MP RVU=0.49,MPGPCI=0.619

3.12374+1.87371+0.30331=5.30076

5.30076*34.0376=180.46

c

W RVU=4.62,W GPCI=0.998,PE RVU=4.14,PE GPCI=0.981,MP RVU=0.76,MP GPCI=0.619

4.61076+4.06134+0.47044=9.14254

9.14254*34.0376=311.2

d

W RVU=4.62,WGPCI=0.998,PE RVU=3.54,PE GPCI=0.981,MP RVU=0.76,MP GPCI=0.619

4.61076+3.47274+0.47044=8.55394

8.55394*34.0376=291.16

e

W RVU=3.17,WG PCI=O.998,PE RVU=5.53,PE GPCI=0.981,MP RVU=0.50,MP GPCI=0.619

3.16366+5.42493+0.3095=8.89809

8.89809*34.0376=302.87

f

W RVU=3.17,W GPCI=0.998,PE RVU=3.24,PE GPCI=0.981,MP RVU=0.50,MP GPCI=0.619

3.16366+3.17844+0.3095=6.6516

6.6516*34.0376=226.40

Nightingale answered 2 years ago

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Physician Payments: Relative Value Units Last week we learned the calculation of payments for physician services.P RVU Information 2012: Code 44389 Work 3.13; PE (Non Facility) 8.4; PE (Facility) 1.91; MP 0.49 Code 58800 Work 4.66; PE (Non Facility) 4.12; PE (Facility) 3.56; MP 0.79 Code 13100 Work 3.17; PE (Non Facility) 5.56; PE (Facility) 3.28; MP 0.50 Conversion Factor $34.0376 GPCI Information. 2012: Work GPCI: 0.998 PE GPCI: 0.981 MP GPCI: 0.619 Code Description...

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