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Provider Production

*Total RVUs

RRVUs can be calculated with the RVU calculator, which can be accessed on the Provider Production tab of your survey.

Report total RVUs performed only by the physician/advanced practice provider you are submitting. If total RVUs are reported, respondents must complete the question “Does this provider's productivity include any that is not their own?” and “% of TC Included in Collections and Charges.” If your practice cannot break out RVUs only performed by the individual physician/advanced practice provider you are submitting, report RVUs and answer “Yes” to the question regarding external provider productivity. If you can report RVUs only performed by the individual physician/advanced practice provider you are submitting, answer “No” for the question regarding external provider productivity.
Include:

  • RVUs for the “physician work RVUs,” “practice expense,” and “malpractice RVUs,” including any adjustments made as a result of modifier usage;

  • RVUs for all professional medical and surgical services performed by physicians, advanced practice providers, and other physician extenders such as nurses and medical assistants;

  • RVUs for the professional component of laboratory, radiology, medical diagnostic and surgical procedures;

  • For procedures with either no listed CPT code or with an RVU value of zero, RVUs can be estimated by dividing the total gross charges for the unlisted or unvalued procedures by the practice’s known average charge per RVU for all procedures that are listed and valued;

  • RVUs for procedures for both fee-for-service and capitation patients; and

  • RVUs for all payers, not just Medicare.

Do not include:

  • RVUs for other scales such as McGraw-Hill, California;

  • The technical component (TC) associated with any medical diagnostic, laboratory, radiology, or surgical procedure. If your practice cannot break this out, report RVUs and select the appropriate response to the question regarding technical component. If you can report total RVUs without technical component, answer 0% for the technical component question;

  • RVUs attributed to advanced practice providers or any other external provider within the physician RVU data; or

  • RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral).

 

*Work RVUs

Report work RVUs performed only by the physician/advanced practice provider you are submitting. If
work RVUs are reported, respondents must complete the question “Does this provider's productivity
include any that is not their own?” If your practice cannot break out RVUs only performed by the
individual physician/advanced practice provider you are submitting, report RVUs and answer “Yes”
to the question regarding external provider productivity. If you can report RVUs only performed by
the individual physician/advanced practice provider you are submitting, answer “No” for the question
regarding external provider productivity.
Include:

  • RVUs for the “physician work RVUs” only, including any adjustments made as a result of
    modifier usage;

  • Work RVUs for all professional medical and surgical services performed by providers;

  • Work RVUs for the professional component of laboratory, radiology, medical diagnostic, and surgical procedures;

  • Work RVUs for all procedures performed by the medical practice. For procedures with either no listed CPT code or with an RVU value of zero, RVUs can be estimated by dividing the total gross charges for the unlisted or unvalued procedures by the practice’s known average charge per RVU for all procedures that are listed and valued;

  • Work RVUs for procedures for both fee-for-service and capitation patients;

  • Work RVUs for all payers, not just Medicare;

  • Work RVUs for purchased procedures from external providers on behalf of the practice’s fee forservice patients;

  • Anesthesia practices should provide the physician work component of the RVU for flat fee procedures only such as lines, blocks, critical care visits, intubations, and post-operative management care; and

  • All RVUs associated with professional charges, including both medically necessary and cosmetic RVUs.

Do not include:

  • RVUs for “malpractice RVUs” or “practice expense RVUs”;

  • RVUs attributed to advanced practice providers or any other external provider within the physician RVU data;

  • RVUs for other scales such as McGraw-Hill or California;

  • RVUs for purchased procedures from external providers on behalf of the practice’s capitation patients;

  • RVUs that have been weighted by a conversion factor. Do not weigh the RVUs by a  conversion  factor;

  • RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral); or

  • Anesthesiology departments. Instead, provide ASA units and leave this question blank.

 

More information on RVUs

Report the relative value units (RVUs), as measured by the Resource Based Relative Value Scale
(RBRVS), not weighted by a conversion factor, attributed to all professional services. An RVU is a
nonmonetary standard unit of measure that indicates the value of services provided by physicians,
advanced practice providers, and other healthcare professionals. The RVU system is explained
in detail in the November 15, 2019 Federal Register, pages 62568-63563. Addendum D: Relative
Value Units (RVUs) and Related Information presents a table of RVUs by CPT code. Your billing
system vendor should be able to load these RVUs into your system if you are not yet using RVUs for
management analysis. When answering this question, note the following:

  • The RVUs published in the November 15, 2019 Federal Register, effective for calendar year 2020, should be used; and

  • The total RVUs for a given procedure consist of three components:

    • Physician work RVUs;

    • Practice expense (PE) RVUs; and

    • Malpractice RVUs.

Thus, total RVUs = physician work RVUs + practice expense RVUs + malpractice RVUs.

  • For 2020, there were two different types of practice expense RVUs:

    • Fully implemented nonfacility practice expense RVUs; and

    • Fully implemented facility practice expense RVUs.

  • “Nonfacility” refers to RVUs associated with a medical practice that is not affiliated with a hospital and does not utilize a split billing system that itemizes facility (hospital) charges and professional charges. “Nonfacility” also applies to services performed in settings other than a hospital, skilled nursing facility, or ambulatory surgery center. You should report total RVUs that are a function of “nonfacility” practice expense RVUs.

  • “Facility” refers to RVUs associated with a hospital affiliated medical practice that utilizes a split billing fee schedule where facility (hospital) charges and professional charges are billed separately. “Facility” also refers to services performed in a hospital, skilled nursing facility, or ambulatory surgery center. If you are a hospital affiliated medical practice that utilizes a split billing fee schedule, you should report your total RVUs as if you were a medical practice not affiliated with a hospital.

  • To summarize, there are two different types of total RVUs:

    • Fully implemented nonfacility total RVUs; and

    • Fully implemented facility total RVUs.

  • The Federal Register Addendum D presents six columns of RVU data. The column labeled “Physician work RVUs” is what you should report as work RVUs. Any adjustments to RVU values through periodic adjustments and updates made by CMS should be included.

 

ASA Units
<Anesthesiology Providers Only> 

For anesthesiology providers, provide the American Society of Anesthesiologists (ASA) units. The ASA units for a given procedure consist of three components:

  • Base unit;

  • Time in 15-minute increments; and

  • Risk factors.

Please note:

  • Adjustments should be made if provider supervises a CRNA that is not employed by the reporting practice; and

  • Do not duplicate units for split bills. Instead, report units on a per case basis.

 

Collections for Professional Charges

Report the amount of collections attributed to a physician for all professional services. If collections
for professional charges are reported, respondents must complete the questions “Does this
provider's productivity include any that is not their own?” and “% of TC Included in Collections and
Charges.”
Include:

  • Fee-for-service collections;

  • Allocated capitation payments;

  • Administration of chemotherapy drugs; and

  • Administration of immunizations.

Do not include:

  • Collections on drug charges, including vaccinations, allergy injections, biologics, and
    immunizations, as well as chemotherapy and antinauseant drugs if the physician themselves administer;

  • The technical component associated with any laboratory, radiology, medical diagnostic or surgical procedure collections. If your practice cannot break this out, report collections and select the appropriate response to the question regarding technical component. If you can report collections without technical component, answer 0% for the technical component question;

  • Collections attributed to advanced practice providers. If your practice cannot break this out, report collections and answer “Yes” to the question in this section regarding external advanced practice provider productivity. If you can report collections without advanced practice providers, answer “No” for the advanced practice provider question;

  • Infusion-related collections;

  • Facility fees;

  • Supplies; or

  • Revenue associated with the sale of hearing aids, eyeglasses, contact lenses, etc.

Professional Gross Charges

Report the total gross patient charges attributed to a physician for all professional services. If
professional gross charges are reported, respondents must complete the questions “Does this
provider's productivity include any that is not their own?” and “% of TC Included in Collections and
Charges.” Gross patient charges are the full dollar value, at the practice’s established undiscounted
rates, of services provided to all patients, before reduction by charitable adjustments, professional
courtesy adjustments, contractual adjustments, employee discounts, bad debts, etc. For both
Medicare participating and nonparticipating providers, gross charges should include the practice’s
full, undiscounted charge and not the Medicare limiting charge.
Include:

  • Fee-for-service charges;

  • In-house equivalent gross fee-for-service charges for capitated patients;

  • Administration of chemotherapy drugs; and

  • Administration of immunizations.

Do not include:

  • Charges for drugs, including vaccinations, allergy, injections, biologics, and immunizations as well as chemotherapy, and antinauseant drugs;

  • The technical component associated with any laboratory, radiology, medical diagnostic or surgical procedure. If your practice cannot break this out, report gross charges and select the appropriate response to the question regarding technical component. If you can report charges without technical component, answer 0% for the technical component question;

  • Charges attributed to advanced practice providers. If your practice cannot break this out, report gross charges and answer “Yes” to the last question in this section regarding external advanced practice provider productivity. If you can report collections without advanced practice providers, answer “No” for the nonphysician provider question;

  • Infusion-related charges;

  • Facility fees;

  • Supplies; or

  • Charges associated with the sale of hearing aids, eyeglasses, contact lenses, etc.

 

*DID THIS PROVIDER'S PRODUCTIVITY INCLUDE ANY THAT WAS NOT THEIR OWN?

State if the productivity measures (collections, charges, encounters, E/M procedures, RVUs, ASA
units) include productivity attributed to an advanced practice provider working under a physician's
supervision by selecting “Yes" or “No."

*CAN ADVANCED PRACTICE PROVIDER BILL UNDER THEMSELF?
<ADVANCED PRACTICE PROVIDERS ONLY>

For advanced practice providers only, indicate if they can or cannot bill the procedures they perform
under themselves, as opposed to under a physician within the practice.

*% of TC Included in Collections and Charges

Collections for professional charges and gross charges for laboratory, radiology, medical diagnostic
and surgical procedures may have two components: the physician’s professional charge such as
interpretation and the technical charge for the operation and use of the equipment. If collections
for professional charges and gross charges did not include the technical component (TC), referred
to as professional services only billing, select “0%.” If collections for professional charges and
gross charges did include the technical component, referred to as global fee billing, indicate the
approximate percentage of charges represented by the technical component by selecting either
“1-10%” or “greater than 10%.”

Total Encounters

If encounters are reported, respondents must complete the question regarding if advanced practice
providers are included in productivity. An encounter is a documented interaction, regardless of
setting (including tele-visits and e-visits), between a patient and healthcare provider(s) for the
purpose of providing medical services, assessing illness or injury, and determining the patient's
health status. If a patient sees two different providers on the same day for one diagnosis, it is one
encounter. If a patient sees two different providers on the same day for two unrelated issues, then
it is considered two encounters. Encounters are procedures from the evaluation and management
chapter (CPT codes 99201-99499) or the medicine chapter (CPT codes 90281-99607) of the
Physicians’ Current Procedural Terminology, Fourth Edition, copyrighted by the American Medical
Association (AMA).
Include:

  • Pre- and post-operative visits and other visits associated with a global charge;

  • Visits that resulted in a coded procedure;

  • For diagnostic radiologists and pathologists, report the total number of procedures or reads, regardless of place of service;

  • For obstetrics care, where a single CPT-4 code is used for a global service, count each as a separate ambulatory encounter (e.g., each prenatal visit and postnatal visit is one encounter). Count the delivery as a single encounter; and

  • Encounters that include procedures from the surgery chapter (CPT codes 10021-69979) or anesthesia chapter (CPT codes 00100-01999).

Do not include:

  • Encounters attributed to advanced practice providers. If your practice cannot break this out, report encounters and answer “Yes” on the question if Advanced Practice Providers can bill under
    them self;

  • Encounters with direct provider to patient interaction for the specialties of pathology or diagnostic radiology (see #3 above under "Include");

  • Visits where there is not an identifiable contact between a patient and a physician or advanced practice provider (i.e., patient comes into the practice solely for an injection, vein puncture, EKGs, EEGs, etc. administered by an RN or technician);

  • Administration of chemotherapy drugs; or

  • Administration of immunizations.

 

Number of Outpatient E/M Codes

If outpatient E/M codes are reported, respondents must complete the question regarding whether
providers productivity included any that is not their own.
Include:

  • 90791, 99201-99499, Psychiatric diagnostic evaluation;

  • 90792, 99201-99499, Psychiatric diagnostic evaluation with medical services;

  • 99201-99205, 99211-99215, office or other outpatient services;

  • 99217-99220, 99234-99236, hospital observation services;

  • 99241-99245, office consultations;

  • 99281-99288, emergency department services;

  • 99304-99310, 99315-99316, 99318, nursing facility services;

  • 99324-99328, 99334-99337, domiciliary, rest home or custodial care services;

  • 99339-99340, domiciliary, rest home, or home care plan overnight services;

  • 99341-99345, 99347-99350, home services;

  • 99354-99355, prolonged physician service in the office or outpatient setting;

  • 99366-99368, medical team conference;

  • 99374-99375, 99377-99380, care plan oversight services;

  • 99381-99387, 99391-99397, 99401-99404, 99406-99409, 99411-99412, 99420, 99429, preventive medicine services;

  • 99441-99444, non-face-to-face physician services;

  • 99446-99449, interprofessional telephone/internet consultations;

  • 99450, 99455-99456, special evaluation and management services;

  • 99461, normal newborn care in other than hospital or birthing room setting;

  • 99483, cognitive assessment and care plan services; and

  • 99492-99494, psychiatric collaborative care management services.

Do not include:

  • 99499, unlisted evaluation and management services; or

  • Evaluation and management codes attributed to advanced practice providers. If your practice cannot break this out, please answer “Yes” to the question in this section regarding the providers productivity including any that is not their own. If your providers productivity does not include any that is not their own, answer "No".

 

Number of Inpatient E/M Codes

If inpatient E/M codes are reported, respondents must complete the question regarding if providers
productivity included any that is not their own.
Include:

  • 99221-99223, 99231-99233, 99238-99239, hospital inpatient services;

  • 99251-99255, inpatient consultations;

  • 99291-99292, 99471-99472, 99468-99469, critical care services;

  • 99356-99359, prolonged physician service in the inpatient setting;

  • 99360, physician standby services;

  • 99366-99368, medical team conference;

  • 99460, 99462-99465, newborn care;

  • 99466-99467, pediatric patient transport;

  • 99468-99476, inpatient neonatal and pediatric critical care;

  • 99477, initial hospital care, neonatal intensive care services;

  • 99478-99480, subsequent hospital care, neonatal intensive care services;

  • 99487-99490, complex chronic care coordination;

  • 99495-99496, transitional care management services; and

  • 99497-99498, advance care planning.

Do not include:

  • 99499, unlisted evaluation and management services; or

  • Evaluation and management codes attributed to advanced practice providers. If your practice cannot break this out, please answer “Yes” to the question in this section regarding the providers productivity including any that is not their own. If your providers productivity does not include any that is not their own, answer "No".

 
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