The Division of Workers’ Compensation has issued a notice of public hearing to revise the recently adopted resource – based relative value scale (RBRVS) based physician fee schedule. The public hearing has been scheduled for 10 a.m., December 12 , in Room 1 of the Elihu Harris Building, 1515 Clay Street, Oakland, CA 94612. Members of the public may also submit written comment on the regulations until 5 p.m. that day.
The RBRVS base d physician fee schedule regulations (Title 8, Code of Regulations, Sections 9789.12.1, et seq.) were adopted by the Acting Administrative Director, and filed with the Secretary of State on September 24, 2013, and will be effective January 1, 2014. The proposed amendment to the RBRVS based physician fee schedule regulations eliminates use of the Federal Office of Workers’ Compensation Program relative value units set forth in Sections 9789.12.3 and 9789.19.
The notice and text of the regulations can be found on the proposed regulations page
Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all Health maintenance organizations (HMOs). RBRVS assigns procedures performed by a physician or other medical provider a relative value which is adjusted by geographic region (so a procedure performed in Manhattan is worth more than a procedure performed in Dallas). This value is then multiplied by a fixed conversion factor, which changes annually, to determine the amount of payment. RBRVS determines prices based on three separate factors: physician work (54%), practice expense (41%), and malpractice expense (5%). RBRVS was created at Harvard University in their national RBRVS study from December 1985 and published on September 29, 1988.
Physicians bill their services using procedure codes developed by a seventeen member committee known as the CPT Editorial Panel. The AMA nominates eleven of the members while the remaining seats are nominated by the Blue Cross and Blue Shield Association, the Health Insurance Association of America, CMS, and the American Hospital Association. The CPT Committee issues new codes twice each year.
A separate committee, the Specialty Society Relative Value Scale Update Committee (RUC),meets three times a year to set new values, determines the Relative Value Units (RVUs) for each new code, and revalues all existing codes at least once every five years. The RUC has 29 members, 23 of whom are appointed by major national medical societies. The six remaining seats are held by the Chair (an AMA appointee), an AMA representative, a representative from the CPT Editorial Panel, a representative from the American Osteopathic Association, a representative from the Health Care Professions Advisory Committee and a representative from the Practice Expense Review Committee. Anyone who attends its meetings must sign a confidentiality agreement.