{"id":35,"date":"2020-11-03T19:34:43","date_gmt":"2020-11-03T19:34:43","guid":{"rendered":"https:\/\/12uh.com\/ioectr\/?p=35"},"modified":"2021-09-06T12:45:48","modified_gmt":"2021-09-06T12:45:48","slug":"facility-versus-non-facility-physician-expense-rvus-for-90-day-global-procedures","status":"publish","type":"post","link":"https:\/\/12uh.com\/ioectr\/facility-versus-non-facility-physician-expense-rvus-for-90-day-global-procedures\/","title":{"rendered":"Facility Versus Non-Facility Practice Expense RVU\u2019s For 90-Day Global Procedures"},"content":{"rendered":"\n

For the purpose of this project and analysis there are two types of surgical procedures. Updated Sep 2021.<\/h4>\n\n\n\n
<\/td>Facility OR office-based<\/strong><\/td>Facility-Only<\/strong><\/td><\/tr>
1<\/td>Those that can be performed in the office or a facility (ASC, hospital outpatient department [HOPD] or hospital).<\/td>Considered \u201cFacility-Only\u201d.<\/td><\/tr>
2<\/td>There is a Site of Service Differential. Physician compensated for use of office surgical suite.<\/td>No Site of Service Differential. No compensation for office surgical suite.<\/td><\/tr>
3<\/td>Facility PE (Practice Expense) RVUs and Non-Facility PE RVUs are different.<\/strong><\/td>Facility PE RVUs and Non-Facility PE RVUs are the same.<\/strong><\/td><\/tr>
4<\/td>The office overhead reimbursement is included in the NON-FAC PE. This is essentially a \u201cfacility fee\u201d for the office (POS=11).<\/td>The facility reimbursement is separate from the FAC PE. ASC, hospital outpatient, or hospital are paid separately.<\/td><\/tr>
5<\/td>Applies to both 90-day and 10-day procedures; 10-day procedures generally have lower RVU\u2019s.<\/td>More 90-day procedures (but not all). Procedures are generally more complicated or risky.<\/td><\/tr>
6<\/td>These can be routinely performed in the office. There is no issue.<\/td>Not routinely performed in the office. Our focus is on these procedures. The issue is migrating procedures traditionally performed in an ASC to the office.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

\u201cFacility-only\u201d procedures are typically more complex, have higher total RVUs, require regional or general anesthesia, and have a higher level of risk (patient safety). Some are more apparent than others. Exceptions abound. Some complex procedures have a Site of Service Differential and some minor procedures do not. An office-based surgery (OBS) is submitted on one form, the CMS-1500, by the physician; when performed in the facility, two claims<\/em> are submitted: the CMS-1500 form by the physician and a UB-04 claim form by the facility for facility fees.<\/p>\n\n\n\n

An example is given below. Open carpal tunnel release has a Site of Service Differential and is therefore considered an office or<\/em> facility procedure. Endoscopic carpal tunnel release is considered \u201cfacility-only\u201d and there is no Site of Service Differential (the Facility PE and the Non-Facility PE are the same). While the procedure may be reimbursed if performed in the office, there would be no compensation for the use of the office surgery suite.<\/p>\n\n\n\n

<\/a>29848: Endoscopy, wrist, surgical, with release of transverse carpal ligament (ECTR)<\/a><\/h4>\n\n\n\n

Procedure 29848 priced for 1\/29\/2021 (No Site of Service Differential<\/strong>)<\/p>\n\n\n\n

Procedure 29848 priced for 01\/29\/2021<\/td> <\/td> <\/td>Atlanta GA<\/td><\/tr>
 <\/td> <\/td>Medicare Facility<\/td>Medicare Non Facility<\/td><\/tr>
Global<\/td>Allowed<\/td>$521.78<\/td>$521.78<\/td><\/tr>
 <\/td>Reimbursement<\/td>$417.42<\/td>$417.42<\/td><\/tr>
 <\/td>After Sequest<\/td>$409.08<\/td>$409.08<\/td><\/tr>
 <\/td>RVUw<\/td>6.39<\/td>6.39<\/td><\/tr>
 These are the same<\/td>RVUpe<\/strong><\/td>7.51<\/strong><\/td>7.51<\/strong><\/td><\/tr>
 <\/td>RVUm<\/td>1.23<\/td>1.23<\/td><\/tr>
 <\/td>RVU total<\/td>15.12<\/td>15.12<\/td><\/tr>
Global period: 90 days<\/td> <\/td> <\/td> <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

In the Table above we see the Work RVU\u2019s (RVUw), the Practice Expense RVU\u2019s (RVUpe), and the Malpractice RVU\u2019s (RVUm). Together these are total RVU\u2019s for the procedure.<\/p>\n\n\n\n

The Facility reimbursement and Non-Facility reimbursement PE RVUs, above<\/strong> are the same<\/strong> (7.51). This amount is what the clinic needs to negotiate, individually, with all of your main carriers. The ASC facility reimbursement, for CPT code 29848 is roughly $713 and paid separately to the ASC.<\/p>\n\n\n\n

There are 1,174 orthopedic procedures that fall into this \u201cfacility-only\u201d category. A complete list is available on the website<\/a>. There is also a shorter list of 97 hand-and-wrist procedures that might lend themselves to WALANT.<\/p>\n\n\n\n

<\/a>64721: Neuroplasty and\/or transposition; median nerve at carpal tunnel<\/a><\/h4>\n\n\n\n

Procedure 64721 priced for 1\/29\/2021<\/p>\n\n\n\n

Procedure 64721 priced for 01\/29\/2021<\/td> <\/td> <\/td>Atlanta GA<\/td><\/tr>
 <\/td> <\/td>Medicare Facility<\/td>Medicare Non Facility<\/td><\/tr>
Global<\/td>Allowed<\/td>$443.98<\/td>$451.64<\/td><\/tr>
 <\/td>Reimbursement<\/td>$355.18<\/td>$361.31<\/td><\/tr>
 <\/td>After Sequest<\/td>$348.08<\/td>$354.09<\/td><\/tr>
 <\/td>RVUw<\/td>4.97<\/td>4.97<\/td><\/tr>
 Different Values<\/strong><\/strong><\/td>RVUpe<\/td>6.9<\/td>7.13<\/td><\/tr>
 <\/td>RVUm<\/td>1<\/td>1<\/td><\/tr>
 <\/td>RVU total<\/td>12.87<\/td>13.1<\/td><\/tr>
Global period: 90 days<\/td> <\/td> <\/td> <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

There is a Site of Service differential for OCTR but it is only $6.14 (.24 RVU\u2019s)! The ASC facility reimbursement, for CPT code 64721 is $796.79 or over 10X the amount. One could question why is the OCTR facility reimbursement higher than ECTR facility reimbursement? I don\u2019t know the answer. In this case, there is<\/em> compensation for performing the procedure in the office (Non-FAC PE) but it is very low. There are 471 orthopedic codes with<\/strong> a positive SOSD<\/strong>. But there are over a thousand with a zero SOSD.<\/p>\n\n\n\n

The challenge is to work with clinics, surgeons, and professional associations to negotiate proper Non-FAC PE (overhead\/facility fee) reimbursement from the insurance company for office-based (ECTR)(short-term) and lobby the AMA and Medicare to establish NON-FAC PE’s for ECTR (long-term). There are dozens of orthopedic procedures that fall into this category.<\/p>\n","protected":false},"excerpt":{"rendered":"

For the purpose of this project and analysis there are two types of surgical procedures. Updated Sep 2021. Facility OR office-based Facility-Only 1 Those that can be performed in the office or a facility (ASC, hospital outpatient department [HOPD] or hospital). Considered \u201cFacility-Only\u201d. 2 There is a Site of Service… Continue reading → <\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4,3],"tags":[16,10,24,9,28,8,15,29,14,11,26,12,18,23,17,21,19,20,27],"class_list":["post-35","post","type-post","status-publish","format-standard","hentry","category-4","category-reimbursement","tag-carpal-tunnel-release","tag-carrier-reimbursement","tag-cubital-tunnel-release","tag-endoscopic-soft-tissue-release","tag-fac-pe-rvus-2","tag-facilty-fee","tag-in-office-endoscopic-carpal-tunnel-release","tag-ioectr","tag-ioestr","tag-medicare-reimbursement","tag-non-fac-pe-rvus-2","tag-non-facility-physician-expense-relative-value-units","tag-obs-benefits","tag-obsreimbursement-com","tag-office-based-surgery-reimbursement","tag-rvus","tag-site-of-service-differential","tag-walant","tag-wide-awake-local-anesthesia-with-no-tourniquet-2"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/posts\/35","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/comments?post=35"}],"version-history":[{"count":5,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/posts\/35\/revisions"}],"predecessor-version":[{"id":393,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/posts\/35\/revisions\/393"}],"wp:attachment":[{"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/media?parent=35"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/categories?post=35"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/12uh.com\/ioectr\/wp-json\/wp\/v2\/tags?post=35"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}