CDEO Chapter 7 Exam Study Guide
RBRVS - answerResource-Based Relative Value Scale
RBRVS System - answerEstablished by Medicare to reimburse physicians based on CPT
code submitted for reimbursement
RVU - answerEach CPT code has an assigned relative value unit which, when multiplied by
conversio...
RBRVS - answer✔✔Resource-Based Relative Value Scale
RBRVS System - answer✔✔Established by Medicare to reimburse physicians based on CPT
code submitted for reimbursement
RVU - 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 - 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 - answer✔✔CMS annually publishes Physician Fee Schedule information on its
website and posts the formula for calculating physician fee schedule amounts.
Physician Fee Amounts - answer✔✔vary depending on facility vs non-facility
Facility Practice RVU - answer✔✔expenses include services performed in emergency rooms ,
hospitals, SNFs, nursing homes, ASC.
Non Facility RVUs - answer✔✔include services performed in non-hospital owned physician
practices and privately owned practices.
GPCI - answer✔✔Geographic Practice Cost Index
Geographic Prctice Cost Index - answer✔✔is used to realize the varying cost based on
geographic location
CF - answer✔✔Converstion Factor
Conversion Factor - answer✔✔this is a fixed dollar amount used to translate the RVUs into fees
Other Health Plans - answer✔✔other than Medicare may choose not to use the CMS calculations
to determine provider reimbursement
Global Surgery Package - 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 - 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
* 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 - 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 - answer✔✔defined as having a 1 day operative period and a 90-day
postoperative period
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