Medicare's resource-based relative value scale, a de facto national fee schedule: its implications and uses for...

The institution of the RBRVS as a basis of Medicare reimbursement corrects some long-standing inequities. First, it corrects the magnitude of reimbursement of procedures compared with cognitive services. Second, it corrects unexplained geographical variations in reimbursement. The RBRVS continues to go through refinement. The 5-year review and HCFA's practice expense project are likely to further improve reimbursement for cognitive services. Furthermore, because of the strengths of the scale, the RBRVS is now employed by most payors and is a useful practice management tool. Relative to other specialties, particularly the surgical specialties, neurology has in general benefited from these changes. Yet the RBRVS only addresses the rate of reimbursement; the proliferation of plans and insurance products with different coverage and payment policies and different procedures vastly complicates medical practice management. Understanding the development and evolution of the RBRVS is one necessary element of competent practice management.