Up to code: Your money matters
From time to time, members of the American Psychological Association will receive an email from the Practice Organization asking for your participation in a “RUC Survey.” Even if you’ve never received this type of request before, every psychologist must understand that completing the Relative Value-Scale Update Committee (RUC) surveys helps to determine reimbursement rates for the health care services you provide. Therefore, your input is crucial.
Your participation, whether you’re a Medicare provider or only accept private insurance, is essential to ensuring accurate reimbursement for your practice and the entire psychology profession.
What is the RUC?
When Medicare transitioned to a provider payment system based on the Resource-Based Relative Value Scale, the American Medical Association (AMA) created a multispecialty committee known as the AMA Specialty Society RUC. The RUC acts as an expert panel in making recommendations to the Centers for Medicare and Medicaid Services (CMS) for the creation of or updates to Current Procedure and Terminology (CPT®) codes.
Insurance companies use the values assigned to CPT codes to reimburse providers, including psychologists, for their services. Therefore, even if you are not a Medicare provider, RUC survey outcomes impact every service you bill.
Assigning value to codes
There are more than 10,000 procedure codes published annually in the CPT Manual, and each service is assigned a relative value unit, or RVU. RVUs are based on three components:
- The time and intensity of the provider or physician’s work.
- Practice expenses.
- Professional liability.
The RUC is primarily concerned with the first two components.
The RVUs are then multiplied by Medicare’s annual conversion factor to arrive at the payment for each health care service to the provider. Moreover, while this is how Medicare rates are determined, commercial insurance companies benchmark their annual reimbursement rates against the fees established for the federal healthcare system.
APA and the RUC
APA and the Practice Organization develop new or revise existing codes through the CPT Editorial Panel, and then makes relative value recommendations to the RUC, solely based upon the responses psychologists provide during the RUC survey process. This process can take one to two years to complete and is highly technical and political.
CMS then considers the RUC’s recommendations in reevaluating reimbursement for services, which are paid under the upcoming year’s “Physician Fee Schedule” for services covered under Medicare.
In turn, commercial insurance companies use the annually updated Medicare rates to rationalize their own fees and policies. So, whether or not your patient population includes Medicare beneficiaries, the cooperation and participation of practicing psychologists in the RUC survey process helps ensure all psychologists are reimbursed appropriately for their services.