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163) It has also been suggested that RBRVS is destined to produce mis-valued codes and that overvalued codes will always lead to spending growth.
This model covers that part of the payment method that calculates a single CF rate and not the part that calculates more than 7,500 RBRVS weights.
Medicare reimburses providers by multiplying the RBRVS assigned to each CPT code by the conversion factor and the GPCI.
The RBRVS approach is designed to base reimbursement on the costs of providing care, rather than on actual charges, which was the previous approach.
The RBRVS price limits fell far short of many doctors' actual costs of services, including mine, but the regulations prohibited physicians from charging more than the limiting charges on the RBRVS schedule.
Indeed, a spokesperson for the Blues' association predicted that 20% to 30% of all member plans will adopt some form of RBRVS in the next two to three years.
The RBRVS system, which is to be phased in over five years, has the immediate effect of reducing fees for surgeons and other high paid specialists and increasing fees for primary care physicians, internists, and other cognitive practitioners (Hsiao et al.
Medicare, through the application of diagnosis related groups, has taken the "mystery and obfuscation" out of hospital pricing, and through its RBRVS fee scale will remove much of the "mystery and obfuscation " from physician pricing.
Such a regime would approximate the usual, customary, and reasonable regime of physician pricing that predated the adoption of RBRVS.
But charges continued to rise, eventually leading to the RBRVS and the Physician Fee Schedule.
Milliman White Paper: Using Medicare RBRVS for reimbursing out-of-network claims in commercial insurance.