Help Identifying Changes in the Physician Fee Schedule RVU Files

CMS issues its changes to the Physician Fee Schedule quarterly, but how often do you have the chance to analyze it and review it? With over 15000 lines filling a spreadsheet, comparing each quarter’s changes can be a daunting and time consuming task. Are you aware that MediRegs does this for you? They issue a difference report every quarter that highlights the changes between the current version and the last quarter’s version. Look for the file called “Difference Report” and “MediRegs created.”

In the Regulation and Reimbursement Suite or the Audit and Revenue Center, select the Coding tab and choose the Physician Fee CodeBook under the companion CodeBooks section. Choose the last link-Download Center: Physician Fee Schedule RVU Data Files.

In the Coding and Revenue Resource Center, select the RVU tab and choose the Physician Fee CodeBook under the See Also box on the right. Choose the last link-Download Center: Physician Fee Schedule RVU Data Files.

Even more detail related to quarterly changes is posted to the “Changes and Updates to the PFS CodeBook” page, which can also be accessed from the Physician Fee CodeBook page as described above (it’s typically the file just above the Download Center file).

Can’t remember what the different columns mean? MediRegs solves that too, by posting a Glossary of Terms, which also can be accessed from the Physician Fee CodeBook page (typically the file just above the changes and Updates file). 

Now that you have all of this information at your fingertips, the next step is to analyze the data. Key items are:

RVU values-review your practice’s top procedures. Are there changes to these codes? “Facility” practice expense values are used in hospital or ambulatory surgery centers and the “non-facility” practice expense values are used for services provided in your office.

Day changes-review the global days column to see if there are changes to your typical procedures. This may change the way post-operative visits are billed.

Modifier changes-review the columns that affect the modifiers you might apply to surgery codes: multiple procedures, bilateral procedures, co-surgeons and team surgery.

Typically less changes occur in the second, third and fourth quarters of the year, while major changes to RVUs generally occur in the first quarter coinciding with the new CPT code changes and  the changes to the physician fee schedule. Let MediRegs do the work for you and receive email alerts when new items are posted (similar to what is posted in the What’s New file). Sign up for email alerts in your Settings menu under Activate/Discontinue Email Alerts. 

Written by Kathy Lindstrom, RHIT