RUC Process for Code Valuation

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RUC Process for Code Valuation

Business of Medicine
Author Credentials 

R. Peter Manes, MD
Associate Professor
Yale School of Medicine
New Haven, CT

Module Learning Objectives 
  1. Review the RUC process in detail.
  2. Describe the components of work value.
  3. Delineate the steps in a RUC survey.
What Does RUC Stand For?
  1. Relative Value Scale Update Committee- the AMA committee charged with recommending values for codes to CMS. 
  2. Know the definition of a Relative Value Unit (RVU).
Steps in the RUC Cycle
  1. Codes are submitted to the RUC Staff
    • CPT’s new and revised codes
    • CMS request to review existing codes
  2. Specialty societies review codes and determine their level of involvement
    • Survey the code
    • Comment on the code
    • No action
  3. Specialty societies conduct surveys, prepare data from surveys and review the practice expense involved in a code.
  4. Specialty society advisors present survey data, practice expense and valuation recommendations to the RUC panel
    • RUC panel is 31 members
    • Expert panel, not specialty advocates
  5. RUC may adopt or modify the specialty society recommendation.
  6. RUC recommendation is forwarded to CMS, who may accept or modify the recommendation.

 

Components of Work Value
  1. Physician Work
  2. Practice Expense
  3. Professional Liability Insurance
  4. Total RVU = [(work RVU x work GPCI) + (practice expense RVU x practice expense GPCI) + (malpractice RVU x malpractice GPCI)]
  5. GPCI is the Geographic Practice Cost Index. Accounts for differences in cost between different areas of the United States.
  6. Malpractice RVU estimates the relative risk of each CPT code and is related to the cost of malpractice insurance.
Practice Expense Calculation
  1. Addresses costs of maintaining a practice.
  2. Direct costs are those that can be assigned to a specific CPT code: supplies, equipment, staff time.
  3. Indirect costs are those that cannot be directly attributed to a specific service, such as rent.
  4. There are DIFFERENT RVU’s for facility versus non-facility.
  5. Non-facility practice expense RVU’s are typically higher because the practitioner is carrying the burden of costs. In a facility, the facility incurs the overhead/equipment costs.
  6. Work RVU remains the same in facility versus non-facility.
Components of a RUC Survey
  1. Review code descriptor and vignette (a short description of the patient).
  2. Review introduction and complete contact information.
  3. Identify a reference procedure.
  4. Estimate your time (pretime, intratime and posttime).
  5. Compare the procedure being surveyed to a reference procedure, in terms of time, mental effort and judgment, technical skill and physical effort).
  6. Estimate a work RVU.
Resources 

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