RVU – RBRVS – RVP – What are these?

Here is a question that was recently posed:

We have fee schedules based upon a % of Medicare, multiples of RVUs, multiples of RVPs and multiples of RBRVS.  I will be purchasing a $200 book to obtain the RVPs.  I got the RVUs off of CMS’ website.  I know there is correlation between RVUs and RBRVS’ and was hoping to use it to calculate the expected fee versus buying another book.

RBRVS is the Resource-Based Relative Value Scale. It uses value units (based on the resources required or consumed to provide a medical procedure) to relate medical procedure codes to each other on one scale (i. e. the Relative Value Scale). It was created at Harvard University in 1985 and adopted by Medicare in 1989.

RVU is the Relative Value Unit used by the RBRVS. It actually consists of three components: the provider Work RVU (representing the work of the provider), the Malpractice RVU (for insurance related expenses), and the Practice Expense RVU component which is valued for either the Facility PE RVU (hospital based) or the Non-Facility PE RVU (non-hospital based; i.e. private practice). You add each of these component values to arrive at the RVU value.

The RVU is then used along with some adjusting factors for regional differences and to balance the federal budget to calculate Medicare payments. Other insurance companies also use the RVU in their own ways.

While I don’t generally consider Wikipedia very authoritative, they do have a nice summary at:

http://en.wikipedia.org/wiki/Resource-Based_Relative_Value_Scale

As far as RVP please see below:

Relative Value Principal (RVP) – Formerly published by McGraw-Hill, now published by St. Anthony’s/Ingenix.

RVP is a relative value method used to determine physician reimbursement.  This method has become less and less common, since it is very stable and RBRVS is preferred by commercial insurers for obvious reasons.  In RVP methodology, there is a conversion factor for each “service area”.  Therefore, unlike RBRVS where there is a single conversion factor ($37.8975), RVP has multiple conversion factors set specific to “service areas”.  This is because the relative values in RVP are not all relative to each other but rather to the group that they fall within (i.e. surgery, medicine, radiology,etc..).  The calculation to figure the allowable under RVP methodology is Conversion Factor  X  Relative Value = Allowable…..very simple!  The key is knowing where to set the conversion factors.