What Is a Work Relative Value Unit? Your WRVU Guide
Medicare has established an RVU – Relative Value Unit – for every CPT code to determine reimbursement amounts. The RVU is made up of three components, which include physician work, the practice expense totals, and malpractice.
Here, we are focusing on the physician work RVU. This factor, which is called wRVU, represents a “neutralized” manner of comparing and quantifying the productivity of doctors because it eliminates several variables. These include geographical costs and fee schedules.
In most cases, the wRVUs are multiplied for the services provided by a given conversion factor. This is what determines the amount of compensation a physician receives.
For example, if a surgeon is paid $60 for a wRVU and produces a total of 6,000 wRVUs, they would receive compensation of $360,000.
Seems Simple: What Do You Need to Understand?
While the concept seems simple, there is an old saying – the devil is in the details. The truth is, counting and figuring wRVUs isn’t entirely straightforward. Sometimes there is a lack of transparency between physicians and administrators.
Sometimes this issue is intentional, but in other cases, it isn’t. Regardless, it can sow seeds of doubt that may thrive, growing into an environment of hostility and distrust.
Working with Your Administrator
If you want to avoid the rather dismal sounding destiny mentioned above, you need to work with your administrator. They have the answers you are looking for when it comes to understanding how this system works. Some of the things you can discover when speaking with administrators are found below.
Codes Submitted or Codes Paid?
One of the first things to know is if the administrator credits wRVUs when codes are submitted or when they are paid. Usually, you should receive a credit when the CPT code is submitted. This isn’t based on the reimbursement being received.
While this is true, it is still a good idea to get clarification about it. Also, find out if reports are generated using the date of the service or the date the charge was billed.
This is going to make a difference for the services performed for one month but billed the next month. Remember, if there are delays in billing, regardless of why they occur, it can delay the wRVU credit and compensation being received.
What’s the Impact of Modifiers?
Modifier impacts on wRVUs may cause physicians to think they are “cheated” out of the compensation they have rightfully earned.
Some groups apply a discount to the wRVU on the second side of any bilateral procedures. This is consistent with the reimbursement methods used by most payers today.
An example of this would be CPT code 19318, which is for breast reduction surgery, and that has 16.03 wRVUs. If this is billed as a two-sided procedure (which is done by attaching modifier 50), some payers will reimburse 150% of the total fee schedule, rather than 200%.
Also, the hospital may credit the surgeon with 24.0 wRVUs, rather than 32.06. If a physician finds this type of adjustment several months into their work, they are often shocked at the assumed deception that is going on.
Some of the other modifiers that may reduce wRVUs include:
- Multiple procedures – Modifier 51
- Distinct procedural service – Modifier 59
- Two surgeons or co-surgeons – Modifier 62
- Repeat procedure – Modifier 76
- Assistant surgeon – Modifier 80
- Assistant surgeon if a qualified resident surgeon is unavailable – Modifier 82
Knowing what these are ahead of time can help eliminate confusion in the future.
Credits for Unlisted Procedures
A CPT code for an unlisted procedure, like 64999, which is an unknown procedure applying to the nervous system, aren’t assigned by any wRVU. If you use an unlisted code, talk to your administrator regarding an appropriate value for this service.
You can suggest a procedure that is similar to use as a point of reference. You can also discuss adjustments that may need to be applied to the wRVU to accurately depict the work that is required for the unlisted procedure.
Who Can Change Codes or Modifiers Once Submitted?
An accepted best practice is for a physician to assign the specific CPT code for the services they perform. Usually, after codes are submitted, a biller or coder will review charges and may change the modifiers or codes based on the payer rules and available documentation.
This has a direct impact on the compensation a physician receives. Make sure to pay attention to who is handling your claims.
Be sure you know what protocol is used to make changes and make sure there is some system in place to ensure you are notified if changes occur. Also, make sure that you and the billers and coders are aware of the latest coding updates and changes.
The Availability of Detailed Transaction Reports
Any savvy physician will make it a priority to receive and review their transaction report monthly. This helps ensure that all services were correctly billed and that the right wRVUs was credited for each of the codes.
It is also smart to keep your own personal log of the codes submitted. Take time to reconcile the lists each month to ensure every service provided was captured properly. Making this a monthly habit will pay off.
Understanding wRVU and Avoiding Common Issues
As a physician, there’s no question that you need to keep updated with codes and compensation when it comes to the services you offer. With the tips and information here, you will find that understanding and managing your wRVU is as easy and straightforward as possible.
To learn more about wRVU practices or to find a new billing provider, contact us for a quote. We can help ensure you find a billing service that is up to date with the latest codes and can help ensure physicians are receiving the compensation deserved.
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Author: Mike Cynar
Mike Cynar brings buyers and sellers together by producing reviews and creating non biased webpages allowing users to share their experiences on various products and services. He and his staff write informative articles related to the medical field, legal, and other small business industries.