CDEO Chapter 7; Questions & Answers
RBRVS Correct Answer-Resource-Based Relative Value Scale
RBRVS System Correct Answer-Established by Medicare to reimburse
physicians based on CPT code submitted for reimbursement
RBRVS System Correct Answer-Established by Medicare to reimburse
physicians based on CPT code submitted for reimbursement
RVU Correct Answer-Each CPT code has an assigned relative value unit which,
when multiplied by conversion factor and a geographic region allowance ,
creates the reimbursement for the medical service the CPT code represents
RVU Components Correct Answer-1) Physician work- time, skill, training, and
intensity of service provided
2) Practice Expense - reflects the cost of ancillary personnel, supplies, and
overhead
3) Professional Liability Malpractice Insurance
Using RBRVS Correct Answer-CMS annually publishes Physician Fee Schedule
information on its website and posts the formula for calculating physician fee
schedule amounts.
Physician Fee Amounts Correct Answer-vary depending on facility vs non-
facility
Facility Practice RVU Correct Answer-expenses include services performed in
emergency rooms , hospitals, SNFs, nursing homes, ASC.
, CDEO Chapter 7; Questions & Answers
Non Facility RVUs Correct Answer-include services performed in non-hospital
owned physician practices and privately owned practices.
GPCI Correct Answer-Geographic Practice Cost Index
Geographic Prctice Cost Index Correct Answer-is used to realize the varying
cost based on geographic location
CF Correct Answer-Converstion Factor
Conversion Factor Correct Answer-this is a fixed dollar amount used to
translate the RVUs into fees
Other Health Plans Correct Answer-other than Medicare may choose not to
use the CMS calculations to determine provider reimbursement
Global Surgery Package Correct Answer-The time, effort, and services
required to complete a procedure are bundled together to form a surgery
package . Payment is made for a package of services and not each individual
service provided within the package.
CPT Surgery Package Description Correct Answer-* Subsequent tot he
decision for surgery, E?M Services on the date immediately prior to or on the
date of the procedure including H&P
*Local Anesthesia: defined as local infiltration, metacarpal/metatarsal/digital
block, or topical anesthesia
, CDEO Chapter 7; Questions & Answers
* Operation Itself
* Immediate Post-Operative Care, including dictation of operative notes, talking
with family and other physicians
* Writing Orders
* Evaluation of patient post-anesthesia recovery
* Normal, uncomplicated follow-up care
Minor Surgical Procedures Correct Answer-defined by Medicare as a service
that has 0-10 day postoperative period.
Payment for minor procedures includes same-day services or postoperative care,
intraoperative care, and care within the global period.
Major Surgical Procedures Correct Answer-defined as having a 1 day
operative period and a 90-day postoperative period
Payment for major medical procedures include all related preoperative care,
postoperative care , and intraoperative services.
Global Fee Includes Correct Answer-Preoperative visits beginning eith the
day before the day of surgery
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