The little-known decision-makers for Medicare physicans fees

Have you ever heard of the RUC?

If not, you are not part of the small circle of cognoscenti who know what makes the world go ’round – at least in Medicare. To enter the circle, read on.

In my post last week, I described how Medicare pays physicians for the services they render Medicare beneficiaries. In a nutshell, for a particular service (e.g., a routine office revisit or an appendectomy or a heart transplant) that we shall call Z, Medicare pays a fee calculated with this formula:

Fee_Z = (Work RVU_Z x Work GPCI + PE RVU_Z x PE GPCI + PLI RVU_Z x PLI GPCI) x CV