David H. Wiener, MD, FASE, ASE Advocacy Committee Chair

ASE is an active participant in a process that is little understood, but essential to virtually every U.S. based member. It’s known as the “RUC process,” a series of meetings of the Relative Value Scale Update Committee, or RUC.

Since 1992, payment to physicians for each service under Medicare’s Physician Fee Schedule has been made according to the Resource-Based Relative Value Scale (RBRVS). Each medical service in the Current Procedure and Terminology (CPT) book has a relative value assigned to it, expressed in relative value units, or RVUs. Each consists of three components, namely the physician’s work, the expenses of the physician’s practice, and the cost of malpractice insurance. The RVUs are multiplied by the annual conversion factor to arrive at the payment to the physician.

The RUC was formed by the American Medical Association (AMA) in 1991 to make recommendations to the Centers for Medicare and Medicaid Services (CMS) for updating certain codes in the CPT book. Most physicians are aware that the Medicare conversion factor changes from year to year as authorized by Congress. Not everyone realizes that each year the RUC updates the RVUs for selected codes. These recommendations are considered by CMS in reevaluating reimbursement for services which are paid under the upcoming year’s Physician Fee Schedule.

The RUC panel, which meets 3 times a year, is made up of 29 experts, most of whom are physicians. The panel makes recommendations on values assigned to new and revised codes, and conducts a rolling 5-year review to examine CPT codes that are perceived to be incorrectly valued. Over 100 specialty societies, including the ACC, support this process by collecting data and presenting recommendations to the RUC for the valuation of codes in their practice areas. When codes which affect reimbursement for cardiovascular ultrasound services are being considered, the ACC and ASE collaborate on these presentations.

ASE has applied for, and received, provisionary status as a sub-specialty organization to be part of the AMA and ultimately its RUC process. However, until ASE is approved to be a member in its own right (after three years and hitting other milestones), ASE must collaborate with the ACC to put forth any code recommendations or survey information. To this end, ASE retains a consultant, Denise Garris of the Korris Group, to assist our Advocacy Committee volunteers and staff in preparing presentations for the RUC meetings on codes which impact our members. ASE has also contracted with Dr. Diane Wallis to utilize her extensive knowledge to represent echo at multi-day meetings, presenting information to protect the practices of all U.S.-based echocardiographers. In addition, Peter Rahko, MD, FASE, provides support as ASE’s AMA representative to the AMA House of Delegates (Section on CV Disease).

Here’s where YOU come in. ASE physician members may receive surveys which ask them to answer questions to help determine reimbursement values for their services. CMS has targeted services using a variety of screens and is now focusing on those with high volumes that have not been reviewed in recent years. For echocardiography, codes of interest would be values for 12 lead EKG codes, cardiovascular stress tests, and extracranial ultrasound tests. These services will be examined for potential payment changes in the coming year. In addition, CMS has indicated that it would like all evaluation and management services codes to be reviewed as well. If you receive a survey, PLEASE take this responsibility seriously ! The physician work surveys must be completed by a physician. The survey will ask for an estimate in the time, work and complexity required to perform specific procedures. The survey then asks respondents to compare this information to that for procedures already valued by the RUC. The responses to these surveys are the evidence which we use to support our recommendations at the RUC meetings.

Without accurate data, we cannot expect to receive appropriate reimbursement for our services. If a small number of surveys is returned, a few inaccurate reports can adversely influence the results. Whether you are a physician asked to complete the survey or a sonographer, nurse, or administrator who is asked to help collect the data for practice expense values, your role in this process is essential! The CMS has recognized the expertise of the RUC by adopting 90% of the RUC’s recommendations, so the importance of your participation can’t be overstated.