From concept to CPT code to compensation: how the payment system works

Thorwarth, William T.

doi:10.1016/s1546-1440(03)00020-6

Cited by 31 publications

(13 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed a coding system for the description of medical procedures, and later medical services, using uniform language, the CPT system [3][4][5][6][7].…”

Section: Cpt Codes and The Cpt Editorial Panelmentioning

confidence: 99%

How Is Physician Work Valued?

Jacobs

Lahey

Nichols

et al. 2017

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist of three components: work RVU, practice expense RVU, and malpractice RVU, also known as professional liability insurance RVU. The Centers for Medicare & Medicaid Services retains the final decision-making authority on the RVUs associated with each procedure or service. The purpose of this article is to discuss the role that the CPT codes and the RUC play in the valuation of physician work and to provide an example of how the methodology for valuation of physician work continues to evolve.

show abstract

Section: Cpt Codes and The Cpt Editorial Panelmentioning

confidence: 99%

How Is Physician Work Valued?

Jacobs

Lahey

Nichols

et al. 2017

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Instead, it links reimbursement in one way or another to the underlying cost of providing services. 3 To these established precedents, the Affordable Care Act added several explicit limitations on Medicare's payment formulation and the use of comparative effectiveness research (Exhibit 1). Despite these administrative and legislative constraints, comparative effectiveness research may be able to play a role in Medicare, particularly if a clear vision can be developed for the program's use of research data to help contain costs without restricting access to services.…”

Section: Seeking a Path Forwardmentioning

confidence: 99%

How Medicare Could Use Comparative Effectiveness Research In Deciding On New Coverage And Reimbursement

Pearson

Bach

2010

Health Affairs

View full text Add to dashboard Cite

Medicare must find new ways to achieve cost control without limiting access to beneficial services. We propose a payment model incorporating comparative effectiveness research to encourage Medicare to pay equally for services that provide comparable patient outcomes. The model would include higher payments for services demonstrated by adequate evidence to provide superior health benefits compared to alternative options. New services without such evidence would receive usual reimbursement rates for a limited time but then be reevaluated as evidence emerged. In spite of the substantial political hurdles to changing Medicare reimbursement, efforts should be made to use comparative effectiveness research to reward superior services, improve incentives for cost-effective innovation, and place Medicare on a more sustainable financial footing.

show abstract

“…Codes are billed at the end of each day and submitted to the Ministry of Health, which promptly reimburses radiologists at the end of each month. In contrast, then, to the United States, there is no federal legislation that mandates the scrutiny of medical coding and billing practices, and no concern about abuse issues in radiology coding [12,13]. These organizational arrangements result in substantially lower billing costs for professional services in Canada than in the United States.…”

Section: Policy and Planning Responsibilities For Health Care Delivermentioning

confidence: 99%

The Canadian health care system: Past, present, and future

Stolberg

2004

Journal of the American College of Radiology

View full text Add to dashboard Cite

From concept to CPT code to compensation: how the payment system works

Cited by 31 publications

References 4 publications

How Is Physician Work Valued?

How Is Physician Work Valued?

How Medicare Could Use Comparative Effectiveness Research In Deciding On New Coverage And Reimbursement

The Canadian health care system: Past, present, and future

Contact Info

Product

Resources

About