Understanding the RVU

When negotiating your salary it is important to know what you are worth to the company, the best way to do this is to know how productive you are. One way to do this is through tracking work relative value units (RVU). When you’re in PA school there is so much focus on learning how to diagnosis and treat illnesses to help you pass the PANCE there there is very little, if any, mention of billing and coding; but it is important to understand so that you not only get reimbursed correctly for what you’re doing but more importantly so you don’t commit fraud.

For every patient you see the insurance is billed out a certain amount depending on the level of service. For the places I’ve worked we have coders and a billing department that is taking care of this, however the provider doing the service is still ultimately responsible for what is billed out.

For a fairly standard patient that is seen for follow up they you would typically bill a 99213. A level 4 follow up patient would be a 99214. These codes are known as CPT codes and each CPT code is assigned an RVU. The totalRVU includes things like overhead, malpractice and other costs to performing the service.

A part of the totalRVU is the workRVU. This is a number associated with the CPT codes that shows the value of the work that a provider has done. For every CPT code that is billed out you can find the RVU for that code in  the Medicare Physician Fee Schedule.

For 2017 here is a table of common CPT codes and RVUs that are used for billing in an out-patient setting:

For medicare there is a certain dollar amount attached to each CPT code that is paid out depending on geographical region. For private insurances the amount paid varies depending on contracts, location, etc.

In order to measure your productivity you would add up all the workRVUs for every encounter you have over a certain time period. Most likely your billing department is doing this. If your bonus is based on workRVUs then you should be able to get the workRVU report. At my current position we get quarterly bonuses, but a monthly workRVU report is sent out so I know each month how many workRVU’s I’m generating.

This only works if everything you do is getting billed out under your name. If you are doing shared visits or incident-to billing then the RVUs are assigned to the physician that the visit was billed under. Also, if you are in surgery you might be doing a lot of post-op visits those have a value of 0 and is considered part of the surgery payment; so you might be doing a lot work that is part of the surgical care that is not being assigned to you. If this is the case then it requires more creative tracking of the work you are doing.

This is a quick overview of what an RVU is and how to use it to measure your productivity. Once you are able to understand what exactly an RVU is and how to calculate how many RVUs you’re generating the next step is to use that number to see how you compare to others. You would then want to be able to put a dollar amount to the RVUs, which we will discuss in a future post.

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