BC Advantage - 2022 Issue 8

The CMS Quality Payment Program: Future Impact on the Medicare Physician Fee Schedule

Have you ever wondered how Medicare decides how much to pay for an outpatient office visit? Or the monthly capitated payment we receive for caring for ESRD patients? At a very high level, the process goes something like this:  1.    The American Medical Association routinely convenes a committee called the RVS Update Committee (RUC). 2.    The RUC advises CMS about the “relative value” of one service compared to another, and in this fashion has created a numerical value for every CPT code. For example, the value of 99213 (level 3 office visit...

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