1. What is the Medicare Professional Fee Calculation?

The Medicare Professional Fee calculation determines physician payment based on Relative Value Units (RVUs) multiplied by a conversion factor. This is the standard method Medicare uses to reimburse physicians for services.

2. How Does the Calculator Work?

The calculator uses the Medicare Professional Fee equation:

Where:

• \( Total\ RVU \) — Sum of work RVU, practice expense RVU, and malpractice RVU
• \( 32.35 \) — Current Medicare conversion factor (USD per RVU)

Explanation: The equation multiplies the total RVUs for a service by the annually updated Medicare conversion factor to determine the payment amount.

3. Importance of RVU Calculation

Details: Accurate RVU calculation is crucial for proper Medicare reimbursement, practice revenue forecasting, and understanding the relative value of different medical services.

4. Using the Calculator

Tips: Enter the total RVU value for the service. The value must be greater than 0. The calculator uses the current Medicare conversion factor of $32.35 per RVU.

5. Frequently Asked Questions (FAQ)

Q1: What components make up Total RVU?
A: Total RVU is the sum of three components: Work RVU (physician effort), Practice Expense RVU (overhead costs), and Malpractice RVU (insurance costs).

Q2: How often does the conversion factor change?
A: The Medicare conversion factor is typically updated annually, though mid-year changes can occur due to legislative actions.

Q3: Are RVUs the same for all payers?
A: While Medicare RVUs are standard, private insurers may use different RVU values or conversion factors for the same services.

Q4: Where can I find RVU values for specific CPT codes?
A: The Centers for Medicare & Medicaid Services (CMS) publishes RVU values annually in the Physician Fee Schedule.

Q5: Does this calculation include geographic adjustments?
A: No, this is the base calculation. Actual payments may be adjusted by geographic practice cost indices (GPCIs).