Using Work RVU’s to calculate E/M Coding Acuity Ratios

E/M Monitoring & Benchmarking

E/M Monitoring and Benchmarking will help your practice reduce audit risk, improve compliance, and in many cases increase reimbursements.

CMS’ new Comprehensive Error Rate Test (CERT) found that providers improperly billed 4.2 billion in E/M claims, resulting in a 14% improper E/M payment rate. Improper E/M coding, whether it be due to insufficient documentation or incorrect EHR coding recommendations, can result in major compliance violations and/or potential loss of income for the practice.

Work RVU’s can be used to track coding compliance variances over time and compared among physicians. By taking your total wRVU values for all E/M visits and dividing the result by the number of units for those E/M visits, you get an average wRVU value for all E/M visits rolled up. We call this the wRVU E/M Acuity Ratio.

This value is used to quickly compare the coding levels across physicians by specialty. The higher the Acuity ratio is, the higher the overall coding is. Conversely, the lower the Acuity Ratio is, the lower the overall coding is.

The calculation is a simple ratio of Work RVU values per Unit Billed for each service code group.

Take a look at the example calculations for a batch of Established Office Visits under the Outpatient Services charted below:

wRVU Acuity Raito = Total wRVU/Units

152.85 / 160 = 0.96

Interestingly, the work RVU Value for 99213 is 0.97. So, in this example, we can conclude that the provider is billing at about the same work acuity level as a Level 3 visit or a 99213.

Conclusion

We hope you enjoyed this brief introduction to the Work RVU Acuity Ratio and we certainly hope that it got you thinking.

We actually enjoy this stuff! Don’t hesitate to reach out to any of us at dashboardMD with questions or comments. We’d love to hear how you may be applying these metrics and we’re always happy to help.

In fact – we are attending the 2016 User Conference! Visit us at booth #5