American Health Information Management Association (AHIMA) Certification Practice Exam

What reimbursement system employs the Medicare fee schedule?

1. APCs

2. MS-DRGs

3. RBRVS

4. RUG-III

The correct answer is: RBRVS

The reimbursement system that employs the Medicare fee schedule is the Resource-Based Relative Value Scale (RBRVS). This system is designed to establish a uniform payment structure for physician services under Medicare. RBRVS calculates fees based on the relative value units (RVUs) assigned to various services, which consider the resources needed to provide care, including the work involved, the expenses of maintaining a practice, and the cost of malpractice insurance. Each service receives an RVU value, which is then adjusted for geographic cost variations, and multiplied by a conversion factor, resulting in the final payment amount that providers receive for the services rendered. Understanding RBRVS is crucial as it helps to standardize payment across different medical services and ensures that the reimbursement reflects the complexity and resources necessary for patient care. This contrasts with other systems, like APCs (Ambulatory Payment Classification) for outpatient services, MS-DRGs (Medicare Severity Diagnosis Related Groups) for inpatient stays, and RUG-III (Resource Utilization Groups) for skilled nursing facilities, which follow different methodologies tailored to their specific service settings.