The Relative Value Unit: History, Current Use, and Controversies

https://doi.org/10.1067/j.cpradiol.2015.09.006Get rights and content

The relative value unit (RVU) is an important measuring tool for the work performed by physicians, and is currently used in the United States to calculate physician reimbursement. An understanding of radiology RVUs and current procedural terminology codes is important for radiologists, trainees, radiology managers, and administrators, as this knowledge would help them to understand better their current productivity and reimbursement, as well as controversies regarding reimbursement, and permit them to adapt to reimbursement changes that may occur in the future. This article reviews the components of the RVU and how radiology payment is calculated, highlights trends in RVUs and resultant payment for diagnostic and therapeutic imaging and examinations, and discusses current issues involving RVU and current procedural terminology codes.

Introduction

Understanding physician reimbursement is crucial to the sustained health of any medical practice. Physician reimbursement from The Centers for Medicare and Medicaid Services (CMS) is a 3-step process, which begins with the appropriate coding of the service provided by using a current procedural terminology (CPT®) code.1 Second, the appropriate diagnosis is coded using an International Classification of Diseases (ICD) code.1 Finally, a determination of payment is made based on the CMS resource-based relative value scale (RBRVS).1 The CMS process is important to understand, as other payers typically use the CMS model as a guideline for reimbursement. In radiology, monitoring relative value units (RVUs) also allows practice managers to identify physician payment, productivity, budgeting needs, and cost benchmarking, and also has implications for future hiring needs.

Over the years, there has been an increased focus on incentive-related payment models. During all medical residencies, formal education regarding billing and coding is suggested to be included as a part of the core competency of professionalism by the Accreditation Council on Graduate Medical Education.2 However, multiple studies have shown that trainees are unsatisfied with the quantity and quality of education they are receiving in these areas.2 The purpose of this review is to educate radiologists and radiology practices on how they are compensated under the current RBRVS. The authors review the history and components of the RVU, demonstrate how RVUs are calculated, and provide examples of current RVUs for a variety of imaging examinations and interventional radiology procedures. In addition, they define the role of groups that advocate for radiology reimbursement, and highlight current issues and controversies with this payment model.

Section snippets

History of the RVU

RVUs are a measure of value used in the CMS reimbursement formula for physician services. RVUs are a part of the RBRVS, which was designed to value physician services and to serve as a guide for reimbursement. Before the creation of RVUs, CMS paid for physician services using a “usual, customary, and reasonable” rate, which led to a wide range of payments.1 A large study was authorized by the Congress and conducted by researchers at Harvard University and the American Medical Association (AMA).

Issues and Controversies

There are a multitude of controversial issues regarding radiology reimbursement. Most of these center around RVUs and current procedural terminology (CPT®) coding. Radiologists must be aware of these controversies, as recent changes have led to substantial decreases in reimbursement for diagnostic imaging examinations.

Conclusion

Radiologists must understand the history and current use of RVUs and (CPT®) codes for reimbursement. This knowledge allows radiologists to remain current on controversial issues regarding reimbursement and future payment strategies, so as to understand our role in this new paradigm. Radiologist involvement in regional-, national-, and government-level discussions about future reimbursement models is crucial to ensure that our specialty remains at the forefront of medical advancements and

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