PT Glossary
| RBRVS (Resource Based Relative Value Scale) |
this is a scale of "weights" assigned to particular CPT® codes that takes account of the relative amount of effort taken to perform a procedure based on the cost of supplies, the risk or difficulty and the time spent. The RBRVS is controlled by HCFA. |
| Referral |
the recommendation of a medical professional to seek treatment from another medical provider. Some insurance companies require that on specific plans a referral must be obtained for certain procedures or visits to specialists. The referral consists of an authorization code, a number of visits allowed (if applicable) and an expiration date. This information can be stored and referenced in your EMR. |
| Referring Provider |
the medical provider that referred the patient to another medical provider, often a specialist or for a specific procedure |
| Rendering/Performing Provider |
the provider that is actually treating the patient |
| Risk Pool |
when a group of practices come together for negotiating and contractual reasons (e.g. an IPA). A certain percentage of each amount reimbursed is withheld from the practice and put into a risk pool. This is used to cover unexpected expenses, but if it is not used, then it will be distributed back to the practices. The distribution structure is often based on productivity, profitability and other factors that make it a reward for more efficient operations. |
| ROI (Return on Investment) |
measuring an increase in revenue or a decrease in expenditures based on a specific action |
| ROS (Review of Systems) |
a series of questions related to the specific system or systems that the patient is having complaints about (i.e. respiratory for cold symptoms) |
| Rural Health Clinic (RHC) |
is a health clinic that is contracted by HCFA to provide services to underserved populations. RHCs are reimbursed at a slightly higher level than the normal Medicare allowable. Usually clinics in outlying rural areas where the government needs to encourage practitioners to have clinics, although some "rural" clinics are located in poorer parts of inner cities. RHCs are given a special status and when they bill particular procedures with QB (rural) or QU (urban) modifiers, they will get the higher rate. RHCs usually have to submit claims on a UB-92. |
| RVU (Relative Value Unit) |
the weight within the RBRVS assigned to a particular CPT®. The Total RVU for a CPT® is made up of the Work RVU (the amount of time and effort it takes), the Practice Expense RVU (the overhead cost of that time), and the Malpractice RVU (the likelihood of complications), |
