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Evolution of Military Health System Relative Value Units

Evolution of Military Health System Relative Value Units. Deirdre L. Baker SRA International, Inc. Evolution of MHS RVUs. Development of MHS RVUs System Specific RVUs Future of MHS RVUs Questions. Development of MHS RVUs. Centers for Medicare & Medicaid Services (CMS) INGENIX

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Evolution of Military Health System Relative Value Units

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  1. Evolution of Military Health System Relative Value Units Deirdre L. Baker SRA International, Inc.

  2. Evolution of MHS RVUs • Development of MHS RVUs • System Specific RVUs • Future of MHS RVUs • Questions

  3. Development of MHS RVUs • Centers for Medicare & Medicaid Services (CMS) • INGENIX • MHS Adjustments

  4. CMS

  5. INGENIX

  6. MHS Adjustments • High Frequency Ingenix Zero Weighted Codes • Global Maternity • Global Surgery • Obsolete CPT Codes • Modifiers

  7. High Freq Ingenix Zero Weighted Codes • Top 85% SADR reported CPT codes with an INGENIX RVU of 0, excluding 99499 and ancillary. • Provider Work • Specific Procedures • Groups/Families of CPT Codes • Timed Procedures

  8. Provider Work • Telcons (99371, 99372, 99373) • Work Related Disability Exam by Treating Physician (99455) • Administration of Flu Vaccine (G0008)

  9. Specific Procedures • Follow up to Surgery (99024) • LASIK/PRK (S0800/S0810) • Prenatal and Postpartum Care Visits (0500F-0503F)

  10. Global Maternity

  11. Global Surgery Global Surgical Adjustment SADR Coding

  12. DOD Modifiers 00 Base Modifier Prolonged E&M Service 22 Unusual Procedural Service 26 Professional Component 32 Technical Component 50 Bilateral Procedures 51 Multiple Procedures 90 External Laboratory 99 Multiple Modifiers INGENIX Modifiers (None) Base Modifier 26 Professional Component 53 Discontinued Procedure NU New Durable Medical Equipment RR Rented Durable Medical Equipment UE Used Durable Medical Equipment TC Technical Component Modifiers

  13. DOD Radiology Modifiers -21 Prolonged E&M Service Professional Component * 2 -22 Unusual Procedural Service Professional Component + (Technical Component * 2) -50 Bilateral Procedures (Professional Component * 2) + (Technical Component * 2) -51 Multiple Procedures Technical Component * 2 -99 Multiple Modifiers (Professional Component * 2) + (Technical Component * 4)

  14. System Specific RVUs • MHS Data Repository (MDR)/M2 • Direct Care (SADR) • Purchased Care (Non-institutional HCSRs) • Ancillary • EAS IV • CHCS

  15. Direct Care – SADR RVUs • Simple • Adjusted • PPS Work • PPS Facility • Individual Work • Organizational Work • Provider Work RVU

  16. Relative Value Units (RVUs) in the MDR and M2

  17. Purchased Care - HCSRNI Work RVUs No Global Maternity Adjustment No Global Surgery Adjustment No RVUs for 99024, 0500F-0503F INGENIX Modifiers

  18. CHCS and EAS IV • CHCS MHS Adjusted RVUs DOD Modifiers Work RVU • EAS IV Same initial construction as CHCS except, Composite RVU = Work RVU + Non-Facility Practice Expense RVU

  19. Future of MHS RVUs

  20. Master RVU Table

  21. EAS IV Repository Class 17 Ambulatory CPT Workload Raw statistical amount = number of procedures Weighted statistical amount = number of procedures multiplied by the RVU weight Recommended that Class 17 be used in conjunction with Class 25

  22. EAS IV Repository Class 25 Ambulatory Summary (NO CPT) All records whether completed or not are fed through to EAS. Class 25 contains a completion percentage that can be applied to adjust the dollars to the workload.

  23. EAS IV Repository Class 18 Ancillary CPT Workload Raw statistical amount = number of procedures Weighted statistical amount = number of procedures multiplied by the RVU weight Contains modifiers other than 00.

  24. Questions?

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