Brief RUC Survey Presentation2012MerlinoRecordedwebinar

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Understanding the RUC Survey Instrument:

Understanding the RUC Survey Instrument February 2012

How the survey works:

How the survey works The survey asks you to compare the time, complexity, and work to perform the surveyed procedures to an existing service/procedure/therapy A list of possible reference procedures is provided for comparison purposes Reference Service List (RSL)

Partitioning the survey into steps:

Partitioning the survey into steps STEP 1 – Review code descriptor and vignette (a short description of the patient) STEP 2 – Review introduction & complete contact information STEP 3 – Identify a reference service/procedure STEP 4 – Estimate your time STEP 5 – Compare the survey service or procedure to a reference procedure STEP 6 – Moderate Sedation STEP 7 – Estimate professional work RVU (relative value unit)

STEP 1 Review code descriptor & vignette:

STEP 1 Review code descriptor & vignette The vignette describes a TYPICAL clinical scenario for the procedure You may have performed the service/procedure /therapy on a patient different than the ‘typical’ one described in the vignette – that’s okay.

STEP 1 Continued:

STEP 1 Continued Complete the survey instrument using the typical patient described by your society. The survey instrument allows for you to inform them that you do not believe the typical patient as defined is typical.

STEP 2 Review introduction & complete contact information:

STEP 2 Review introduction & complete contact information Although contact and basic practice information is collected, your name is never forwarded to the AMA or used for tracking purposes. If you have any questions, a specialty society’s contact information will be provided

STEP 3 Identify a reference procedure/service:

STEP 3 Identify a reference procedure/service List of reference codes – the survey includes a list of procedures that have been selected for use as comparison for this survey because their relative values are sufficiently accurate and stable to compare with other services. Select a procedure from the list that is most similar in time and work to the survey CPT code descriptor and typical patient/service described. Reference procedure/service/therapy does not have to be equal in work in your judgment to the surveyed procedure but it should be similar in work

Example: RSL portion of survey::

Example: RSL portion of survey: Background for Question 1 Attached is a list of reference services that have been selected for use as comparison services for this survey because their relative values are sufficiently accurate and stable to compare with other services. The “Work RVU” column presents current Medicare RBRVS work RVUs (relative value units). Select one code that is most similar to the surveyed CPT code descriptor and typical patient/service described in the questionnaire. It is very important to consider the global period when you are comparing the surveyed code to the reference code . XXX A global period does not apply to the code and evaluation and management and other diagnostic tests or minor services performed, may be reported separately on the same day ZZZ Code related to another service and is always included in the global period for the other service (Note: Physician/professional work is associated with intra-services time and in some instances the pre- and post- service time) Question 1 Which of the reference services on the attached list is most similar to the surveyed CPT code descriptor and typical patient/service described on the cover of this questionnaire? Reference CPT code:

STEP 4 Estimate your time:

STEP 4 Estimate your time Using the vignette and the description of service periods, this section of the survey asks you to estimate how much time it takes you when you perform the procedure/service. These estimates should be based on personal experience.

Example: Evaluating Professional Time:

Example: Evaluating Professional Time Pre-service period The pre-service period includes services provided before the service and may include preparing to see the patient, reviewing records, and communicating with other professionals. Question 2 How much of your own time is required per patient treated for each of the following steps in patient care related to this procedure? Indicate your time for the surveyed code at the beginning of the survey. (Refer to definitions.) Pre-service time _____ minutes Intra-service time_____ minutes Post-service time_____ minutes

Intra-Service Period Defined:

Intra-Service Period Defined The intra-service period includes all “skin- to-skin” or “face to face” work that is a necessary part of the procedure/service See definitions of time located in the introduction section of CPT

Example: Evaluating Professional Time:

Example: Evaluating Professional Time Intra-service period (XXX example E&M services office) The intra-service period includes the services provided while you are with the patient and/or family. This includes the time in which the physician/healthcare professional obtains the history, performs an evaluation/ therpay and counsels the patient. Question 2 How much of your own time is required per patient treated for each of the following steps in patient care related to this procedure? Indicate your time for the new/revised code on the front cover. (Refer to definitions.) Pre-service time _____ minutes Intra-service time_____ minutes Post-service time_____ minutes

Example: Evaluating Professional Time:

Example: Evaluating Professional Time Post-service period (XXX example E&M services office) The post-services period includes services provided after the service and may include arranging for further services, reviewing results of studies/tests, and communicating further with the patient, family and other professionals which includes written and telephone reports. Question 2 How much of your own time is required per patient treated for each of the following steps in patient care related to this procedure? Indicate your time for the new/revised code on the front cover. (Refer to definitions.) Pre-service time _____ minutes Intra-service time_____ minutes Post-service time_____ minutes

STEP 5 Compare the procedure to a reference procedure – intensity/complexity:

STEP 5 Compare the procedure to a reference procedure – intensity/complexity In this step you will be asked to compare the complexity and intensity of the procedure being surveyed with the reference procedure In evaluating the work of a service, it is helpful to identify and think about each of the components of a particular service. Focus only on the work that you perform during each of the identified components.

Definitions:

Definitions Professional work includes the following elements: The time it takes you to perform the service The mental effort and judgment necessary with respect to the amount of clinical data that needs to be considered, the fund of knowledge required, the range of possible decisions, the number of factors considered in making a decision and the degree of complexity of the interaction of these factors The technical skill required with respect to knowledge, training and actual experience necessary to perform the service

Definitions continued..:

Definitions continued.. The physical effort required to perform the procedure. Physical effort can be compared by dividing services into tasks and making direct comparisons of tasks. In making the comparison, it is necessary to show that the differences in physical effort are not just reflected accurately by differences in the time involved; if they are considerations of physical effort amount to double counting of physician work in the service

Definitions continued:

Definitions continued Your psychological stress Two kinds of psychological stress are usually associated with professional work. The first is the pressure involved when the outcome is heavily dependent upon skill and judgment and an adverse outcome has serious consequences. The second is related to unpleasant conditions connected with the work that are not affected by skill or judgment. These circumstances would include situations with high rates of mortality or morbidity regardless of the physician’s skill or judgment, difficult patients or families, or physician physical discomfort. The first type is the only form of stress accepted as an aspect of work.

Example: Evaluating Work For the new/revised CPT code and for the reference service you chose, rate the intensity for each component listed on a scale of 1 to 5. (underline one: 1= low; 3 = medium; 5 = high).  :

Example: Evaluating Work For the new/revised CPT code and for the reference service you chose, rate the intensity for each component listed on a scale of 1 to 5. (underline one: 1= low; 3 = medium; 5 = high). Surveyed CPT Code: Mental effort and judgment The range of possible diagnoses and/or management options that must be considered 1 2 3 4 5 The amount and/or complexity of medical records, diagnostic tests, or other information that must be analyzed 1 2 3 4 5 Urgency of medical decision making 2 3 4 5 Technical skill/physical effort Technical skill required 1 2 3 4 5 Physical effort required 1 2 3 4 5 Psychological stress The risk of significant complications, morbidity and/or mortality 1 2 3 4 5 Outcome depends on skill and judgment of physician 1 2 3 4 5 Your Reference Service CPT Code: Mental effort and judgment The range of possible diagnoses and/or management options that must be considered 1 2 3 4 5 The amount and/or complexity of medical records, diagnostic tests, or other information that must be analyzed 1 2 3 4 5 Urgency of medical decision making 2 3 4 5 Technical skill/physical effort Technical skill required 1 2 3 4 5 Physical effort required 1 2 3 4 5 Psychological stress The risk of significant complications, morbidity and/or mortality 1 2 3 4 5 Outcome depends on skill and judgment of physician 1 2 3 4 5

Definitions :

Definitions Physician /psychologist /clinical social workers professional work does not include services provided by support staff who are employed by your practice and cannot bill separately including: Registered Nurses, Licensed Practical Nurses, Medical Secretaries, Receptionists and Technicians

STEP 7 Estimate Work RVU:

STEP 7 Estimate Work RVU VERY IMPORTANT In this final step you will be asked to estimate the work relative value unit (RVU) You are asked to consider the value assigned to the reference procedure in developing your estimate The survey methodology attempts to set the work RVU of the procedure “relative” to the work RVU of the comparable and established reference procedure

Further Questions?:

Further Questions? If you have additional questions about the materials discussed today please contact: Denise Merlino E-mail: merlinohccc@gmail.com Phone: 1-888-606-4222 Or Contact your professional society staff