Provider Compensation and Production Glossary

ASA Units

American Society of Anesthesiologists (ASA) units. The ASA units for a given procedure consist of three components: Base unit, time in 15- minute increments, and risk factors.

Please note:

• Survey participants are instructed to adjust ASA units if the provider supervises a CRNA that is not employed by the reporting practice.

• ​Survey participants are also instructed not to duplicate ASA units for split bills. Instead, units are reported on a per case basis.
   

Collections % TC

The actual dollars collected that can be attributed to a physician for all professional services.

Included:

• Fee-for-service collections;

• Allocated capitation payments;

• Personally performed administration of chemotherapy drugs; and

• Personally performed administration of immunizations.

Not included:

• Collections on drug charges, including vaccinations, allergy injections, and immunizations, as well as chemotherapy and antinauseant drugs;

• The technical component (TC) associated with any laboratory, radiology, medical diagnostic or surgical procedure collections;

• Collections attributed to the advanced practice providers;

• Infusion-related collections;

• Facility fees;

• Supplies; or

• Revenue associated with the sale of hearing aids, eyeglasses, contact lenses, etc.
   

Collections to ASA Units Ratio

Collections
ASA Units
 

Collections to Total RVUs Ratio

Collections
Total RVUs
 

Collections to Work RVUs Ratio

Collections
Work RVUs
 

Encounters

A documented interaction, regardless of setting (including tele-visits and e-visits), between a patient and healthcare provider(s) for the purpose of providing medical services, assessing illness or injury, and determining the patient's health status. If a patient sees two different providers on the same day for one diagnosis, it is one encounter. If a patient sees two different providers on the same day for two unrelated issues, then it is considered two encounters. Encounters are procedures from the evaluation and management chapter (CPT codes 99201-99499) or the medicine chapter (CPT codes 90281-99607) of the Physicians’ Current Procedural Terminology, Fourth Edition, copyrighted by the American Medical Association (AMA).

Included:

• Pre- and post-operative visits and other visits associated with a global charge;

• Visits that resulted in a coded procedure;

• The total number of procedures or reads for diagnostic radiologists and pathologists, regardless of place of service;

• For obstetrics care, where a single CPT-4 code is used for a global service, each is counted as a separate ambulatory encounter (e.g., each prenatal visit and postnatal visit is one encounter). The delivery is counted as a single encounter; and

• Encounters that include procedures from the surgery chapter (CPT codes 10021-69979) or anesthesia chapter (CPT codes 00100-01999).

Not included:

• Encounters attributed to advanced practice providers.

• Encounters with direct provider to patient interaction for the specialties of pathology or diagnostic radiology (see #3 above under "Included");

• Visits where there is not an identifiable contact between a patient and a physician or advanced practice provider (i.e., patient comes into the practice solely for an injection, vein puncture, EKGs, EEGs, etc. administered by an RN or technician);

• Non-personally performed administration of chemotherapy drugs; or

• Non-personally performed administration of immunizations.
   

Evaluation and Management (E/M) Codes 

Custom Reports and Tools

Inpatient Codes

Included:

• 99221-99223, 99231-99233, 99238-99239, hospital inpatient services;

• 99251-99255, inpatient consultations;

• 99291-99292, 99471-99472, 99468-99469, critical care services;

• 99356-99359, prolonged physician service in the inpatient setting;

• 99360, physician standby services;

• 99366-99368, medical team conference;

• 99460, 99462-99465, newborn care;

• 99466-99467, pediatric patient transport;

• 99468-99476, inpatient neonatal and pediatric critical care;

• 99477, initial hospital care, neonatal intensive care services;

• 99478-99480, subsequent hospital care, neonatal intensive care services;

• 99487-99490, complex chronic care coordination;

• 99495-99496, transitional care management services; and

• 99497-99498, advance care planning.

Not included:

• 99499, unlisted evaluation and management services; or

• Evaluation and management codes attributed to advanced practice providers.

Outpatient Codes

Included:

• 90791, 99201-99499, Psychiatric diagnostic evaluation;

• 90792, 99201-99499, Psychiatric diagnostic evaluation with medical services;

• 99201-99205, 99211-99215, office or other outpatient services;

• 99217, 99220-99226, 99234-99236, hospital observation services;

• 99241-99245, office consultations;

• 99281-99288, emergency department services;

• 99304-99310, 99315-99316, 99318, nursing facility services;

• 99324-99328, 99334-99337, domiciliary, rest home or custodial care services;

• 99339-99340, domiciliary, rest home, or home care plan overnight services;

• 99341-99345, 99347-99350, home services;

• 99354-99355, prolonged physician service in the office or outpatient setting;

• 99366-99368, medical team conference;

• 99374-99375, 99377-99380, care plan oversight services;

• 99381-99387, 99391-99397, 99401-99404, 99406-99409, 99411-99412, 99420, 99429, preventive medicine services;

• 99441-99444, non-face-to-face physician services;

• 99446-99449, interprofessional telephone/internet consultations;

• 99450, 99455-99456, special evaluation and management services;

• 99461, normal newborn care in other than hospital or birthing room setting;

• 99483, cognitive assessment and care plan services; and

• 99492-99494, psychiatric collaborative care management services.

Not included:

• 99499, unlisted evaluation and management services; or

• Evaluation and management codes attributed to advanced practice providers.
   

Gross Charges % TC

Gross patient charges are the full dollar value, at the practice’s established undiscounted rates*, of services provided to all patients before reduction by charitable adjustments, professional courtesy adjustments, contractual adjustments, employee discounts, and bad debts. For both Medicare participating and nonparticipating providers, gross charges include the practice’s full, undiscounted charge and not the Medicare limiting charge.

Included:

• Fee-for-service charges;

• In-house equivalent gross fee-for-service charges for capitated patients;

• Personally performed administration of chemotherapy drugs; and

• Personally performed administration of immunizations.

Not included:

• Charges for drugs, including vaccinations, allergy, injections, and immunizations as well as chemotherapy, and antinauseant drugs;

• The technical component associated with any laboratory, radiology, medical diagnostic or surgical procedure;

• Charges attributed to advanced practice providers;

• Infusion-related charges;

• Facility fees;

• Supplies; or

• Charges associated with the sale of hearing aids, eyeglasses, contact lenses, etc.
   

*Undiscounted rates: The full retail prices before Medicare/Medicaid charge restrictions, third-party payer such as commercial insurance and/or managed care organization contractual adjustments, and other charitable, professional courtesy or employee adjustments.

Hours Spent on Directorship per Week 

Medical Directorship  Data Set

The number of hours the physician works on directorship duties during a normal (typical) workweek.

Hours Worked per Week 

Custom Reports and Tools

The actual number of hours the provider worked per week. This includes hours for taking on call because it is reflective of total compensation.
 

Hours Worked per Year 

Custom Reports and Tools

The actual number of hours the provider worked over the fiscal year which includes hours for taking on call because it is reflective of total compensation.
 

Modifier

A factor that causes an increase or decrease to RVU values such as modifiers 21, 22, 51, and 80 for additional complexity or multiple procedures.
 

Relative Value Units (RVUs)

The relative value units (RVUs), as measured by the Resource Based Relative Value Scale (RBRVS), not weighted by a conversion factor, attributed to all professional services. An RVU is a nonmonetary standard unit of measure that indicates the value of services provided by physicians, advanced practice providers, and other health care professionals. The RVU system is explained in detail in the December 28,2020 Federal Register, pages 84472-85377. The Physician Fee Schedule Relative Value Files present tables of RVUs by CPT code. Please note the following:

• The RVUs published in the December 28, 2020 Federal Register, effective for the most recent calendar year (2021), are used; and

• The total RVUs for a given procedure consist of three components:

  • Physician work RVUs;

  • Practice expense (PE) RVUs; and

  • Malpractice RVUs.

Thus, total RVUs = physician work RVUs + practice expense RVUs + malpractice RVUs. For the current year, there are two different types of practice expense RVUs: 1. Fully implemented nonfacility practice expense RVUs; and 2. Fully implemented facility practice expense RVUs.

“Facility” refers to RVUs associated with a hospital affiliated medical practice that utilizes a split billing fee schedule where facility (hospital) charges and professional charges are billed separately. “Facility” also refers to services performed in a hospital, skilled nursing facility, or ambulatory surgery center.

“Nonfacility” refers to RVUs associated with a medical practice that is not affiliated with a hospital and does not utilize a split billing system that itemizes facility (hospital) charges and professional charges. “Nonfacility” also applies to services performed in settings other than a hospital, skilled nursing facility, or ambulatory surgery center. Participants reported total RVUs that are a function of “nonfacility” practice expense RVUs.

Not reported:

Total RVUs are a function of “facility” practice expense RVUs. Hospital affiliated medical practices that utilizes a split billing fee schedule, reported their total RVUs as if they were a medical practice not affiliated with a hospital.
 

Total RVUs

The total RVUs reported in the data set will only reflect those performed by the physician or advanced practice provider in the practice.

Included:

• RVUs for the “physician work RVUs,” “practice expense,” and “malpractice RVUs,” including any adjustments made because of modifier usage;

• RVUs for all professional medical and surgical services performed by providers;

• RVUs for the professional component of laboratory, radiology, medical diagnostic and surgical procedures;

• RVUs for procedures for both fee-for-service and capitation patients; and

• RVUs for all payers, not just Medicare.

Not included:

• RVUs for other scales such as McGraw-Hill, California;

• The technical component (TC) associated with any medical diagnostic, laboratory, radiology, or surgical procedure.

• RVUs attributed to advanced practice providers or any other external provider within the physician RVU data; or

• RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral).
   

Work RVUs

The work RVUs reported in the data set will only reflect those performed by the physician or advanced practice provider in the practice.

Included:

• RVUs for the “physician work RVUs” only, including any adjustments made because of modifier usage;

• Physician work RVUs for all professional medical and surgical services performed by providers;

• Physician work RVUs for the professional component of laboratory, radiology, medical diagnostic, and surgical procedures;

• Physician work RVUs for all procedures performed by the medical practice. For procedures with either no listed CPT code or with an RVU value of zero, RVUs can be estimated by dividing the total gross charges for the unlisted or unvalued procedures by the practice’s known average charge per RVU for all procedures that are listed and valued;

• Physician work RVUs for procedures for both fee-for-service and capitation patients;

• Physician work RVUs for all payers, not just Medicare;

• Physician work RVUs for purchased procedures from external providers on behalf of the practice’s fee-for-service patients;

• Anesthesia practices should provide the physician work component of the RVU for flat fee procedures only such as lines, blocks, critical care visits, intubations, and post-operative management care; and

• All RVUs associated with professional charges, including both medically necessary and cosmetic RVUs.

Not included:

• RVUs for “malpractice RVUs” or “practice expense RVUs”;

• RVUs attributed to advanced practice providers or any other external provider within the physician RVU data;

• RVUs for other scales such as McGraw-Hill or California;

• RVUs for purchased procedures from external providers on behalf of the practice’s capitation patients;

• RVUs that have been weighted by a conversion factor. Do not weigh the RVUs by a conversion factor;

• RVUs where the Geographic Practice Cost Index (GPCI) equals any value other than one. The GPCI must be set to 1.000 (neutral); or

• Anesthesiology departments. The departments reported ASA units.
   

Standardized (Benchmarks Standardized To 100% Billable Clinical Activity)

Academic Compensation Data Set 

Benchmarks reported for providers who have less than 100% billable clinical activity are standardized to 100% billable clinical. For example, if a provider is indicated as 50% billable clinical with 1,000 work RVUs, their billable clinical percentage is multiplied by 2 to standardize to 100% (50%*2 = 100%), and the same multiplier is used for their work RVUs (1,000*2 = 2,000).

Note: Unless specified as Standardized (Std) or otherwise, all academic productivity benchmarks reported are for providers with more than 67% billable clinical activity.