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RBRVS : ウィキペディア英語版
Resource-based relative value scale
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%).〔Percentages are average percentage contributions of each factor, as computed by the Government Accountability Office in 2005, as per reference.〕〔''Medicare physician fees geographic adjustment indices are valid in design, but data and methods need refinement.'' Washington, DC: Government Accountability Office, March 2005. (Publication no. GAO-05-119.)〕
== Example ==
For example, in 2005, a generic 99213 Current Procedural Terminology (CPT) code was worth 1.39 Relative Value Units, or RVUs. Adjusted for North Jersey, it was worth 1.57 RVUs. Using the 2005 Conversion Factor of $37.90, Medicare paid 1.57
* $37.90 for each 99213 performed, or $59.50. Most specialties charge 200–400% of Medicare rates for their procedures and collect between 50–80% of those charges, after contractual adjustments and write-offs.

抄文引用元・出典: フリー百科事典『 ウィキペディア(Wikipedia)
ウィキペディアで「Resource-based relative value scale」の詳細全文を読む



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