2021 : The DNA of RVUs

High quality documentation in Emergency Medicine is now more important than ever.

Proper charting highlights the value of our work, decreases medical legal risk, and facilitates the care of our patients.

In regards to reimbursement,  our charting is essential to optimize the return for the service we provide.

Optimal Documentation facilitates Optimal Reimbursement:

$ 8.37 The potential realized from a proper EKG interpretation.
$ 40.12 Obtained by documenting an appropriate critical care statement.
$ 56.88 The difference between a level 4 and 5 chart recovered by avoiding downcoding.
$ 80.95 Realized through distinguishing “complex” from “simple” abscess drainage.
$ 107.82 The difference between a level 3 and 5 chart recovered by documenting optimally.

(Based on 1 RVU  =  $ 34.89,  2021 Medicare Physician Fee  /  precise amount geographic specific)

This is the potential revenue waiting to be recovered in the setting of omitted or suboptimal documentation for a number of patient encounters.

Optimal charting not only allows clinicians to avoid downcoding, but also enables practitioners to realize their full reimbursement potential.

The DNA of RVUs (Relative Value Units):

Level 1 Encounter: CPT 99281 0.64 RVUs  =  $   22.33
Level 2 Encounter: CPT 99282 1.24 RVUs  =  $   43.27
Level 3 Encounter: CPT 99283 2.09 RVUs  =  $   72.93
Level 4 Encounter: CPT 99284 3.55 RVUs  =  $ 123.87
Level 5 Encounter: CPT 99285 5.18 RVUs  =  $ 180.75

(Based on 2021 Medicare Physician Fee / precise amount geographic specific)

Realize your documentation plays a key role in detailing the work you do.

Notable differences in reimbursement exist between Level 3, 4, and 5 charts.

Emergency Clinicians  –  The Onus is on Us:

For cases involving high levels of care,  a minimum number of charting elements must be fulfilled or significant downcoding will result.

Beyond this,  without our proper documentation,  our coders and insurance carriers may not recognize the medical decision making,  severity of illness,  and / or medical necessity inherent to a given case.

Optimal reimbursement can only be achieved through optimal charting.

The task resides with us,  every physician and advanced practice provider,  to document the appropriate details of the care we provide and detail the appropriate risk and complexity in the cases we manage.

Your Most Valuable Asset:

No super-coder or super-computer system can accomplish what only you can do.

Both of these entities can certainly make an impact on Emergency Medicine efficiency.

However, when it comes to quality charting, your role in this process is essential.

Only you can independently relate the differential diagnosis,  list the appropriate diagnoses,  and convey the appropriate risk and complexity for a given patient encounter.

Learning how to reimburse is a skill that must be learned by Emergency clinicians.

Empower yourself.  Your most valuable asset is you.

Chart Smarter and Optimize Today:

Clinician, you can bridge the gap between your charts and your coders.

Using Chart Optima,  learn how to optimize your charting and reimbursement.

24 / 7  –  Your best resource is here.

What you document does make a difference.


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Best Resource for EM Physicians – Specialized Tutorials – Terms of Use / Purchase:  Chart Optima, LLC., makes a sincere effort to ensure the accuracy and quality of its published materials.  However, no warranty, expressed or implied, is provided.  Each participant should rely specifically on the available regulatory requirements and coding guidance from regulatory or other authoritative agencies.  Chart Optima, LLC., disclaims any responsibility or liability for any direct or indirect damages resulting from the use of the information herein.  The content of Chart Optima is provided as an educational resource only.  Participants should consult their own legal counsel where applicable.  All clinicians should have open communication with the coders who service their site.  Ultimately, it is the responsibility of each provider to ensure submitted claims accurately reflect the service they provide. This product is limited to 3 devices per registered user.  The content of this website is copyrighted and intellectual property of Chart Optima.  This content may not be reproduced or distributed to non-enrolled persons without the expressed written consent of Chart Optima, LLC.  Chart Optima strives to empower Emergency Medicine clinicians to optimize, not maximize, their documentation and its associated reimbursement.  Best wishes for success!

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