Relative value units (RVUs) deliver CPT® content users an objective health care cost foundation for any form of medical payment or reimbursement system.
What are RVUs?
RVUs are used to support the calculation of physician reimbursements. They are an objective way to identify the cost components linked to procedures described in the Current Procedural Terminology (CPT®) code set. The calculations enable health care professionals to combine the time, intensity and cost of care into a single relative ranking scale called the Resource-Based Relative Value Scale (RBRVS).
Goal of the RBRVS
The RBRVS is based on the principle that payments for physician services should correlate directly with the resource costs for providing those services. The goal is to support a payment system and provide an avenue to continuously improve it while procedures modernize.
Calculation of RVUs
RVUs combine components related to the physician’s work, the practice's expenses, and when desired, the liability protection. The calculations are aligned by geographic index adjustments and a health system wide conversion factor to ensure alignment within the reimbursement system.
AMA provides resources to educate users on RVU data for every CPT code as well as the rationale on each CPT code's assignment.
Other RVU uses
In addition to RVUs use as a reimbursement mechanism for specific procedures, RVUs also can facilitate the measurement of physician or group productivity, utilization allocation, cost benchmarking and other performance analytics within a health system, provider or payer.
Example of how to apply RVUs
Capturing RVU data by procedure can help measure and compare resource utilization and productivity against benchmarks or between groups, departments or physicians.
- Calculate the work RVUs (wRVUs) associated (by group or individual) by multiplying the frequency associated with each CPT code billed during the period of time by the wRVU for each CPT code.
- This total wRVU after applying consistent conversion factors to align with spending limits is linked to each group or physician during that period for comparison and benchmarking against either scheduled wRVUs or other comparison groups for productivity.
- RVU totals are one method to begin assessing physician performance, identify variations and causes for the variations, and possibly providing a basis for adjusting remuneration policies.
A panel called the AMA/Specialty Society Relative Value Scale Update Committee (RUC), recommends annual updates to the RVUs assigned to new or revised codes in the changing CPT code set. The RUC's annual cycle for developing recommendations is closely coordinated with the CPT Editorial Panel’s schedule for annual code revisions.