RUC Survey: Your Role in Helping Shape Medicine

By: Jonathan N. Rubenstein, MD, FACS | Posted on: 01 Jan 2022

I am frequently asked by AUA members who receive a Relative Value Scale Update Committee (RUC) survey the following question: “Is it OK that I just delete the email?”

My answer to them is: “No! Do not erase it! You need to fill it out!”

We at the AUA need your help.

From a coding and reimbursement standpoint, there may be no bigger impact that an individual provider can have on their specialty (and to organized medicine) than filling out a RUC survey. Here’s why: the RUC is a multispecialty committee created by the American Medical Association which makes recommendations to the Centers for Medicare & Medicaid Services for valuation of the work, direct practice expense and professional liability insurance values for CPT (Current Procedural Terminology) codes. The RUC became necessary when Medicare transitioned to the Resource-Based Relative Value Scale for Part B reimbursement for the physician fee schedule. The recommendations made by the RUC are typically accepted by the Centers for Medicare & Medicaid Services, which directly and ultimately determines the payment to a provider for their work. The RUC itself involves input from over 100 specialty societies and meets 3 times a year to value new and revised codes and to re-value codes that may be mis-valued. One of the critical inputs to the RUC process is input from specialty societies. This input includes data derived from submissions of RUC surveys by providers who perform the service being valued. Without such surveys (or enough surveys), procedures are not able to be accurately and appropriately valued.

When AUA input is needed to help the RUC value a code, the AUA sends a RUC survey to a random sampling of AUA members asking for their help. It must be random and providers cannot be selected by a subspecialty or specific interest. The survey may include the code being valued and may also include related CPT codes from the same family that will ultimately also be re-valued. Since not everyone receives a survey, it is critical for those who do receive a survey to participate in the process if they are able to do so.

“OK, I get it. You convinced me. So how do I fill out the survey?”

If you receive a RUC survey from the AUA, here is what you will do:

  1. Open the link. See if it is a procedure that you personally perform or have performed recently (typically within the last 5 years). If you do, please continue on with filling out the survey. The survey can be completed online, and you can pause at any time and pick up again later if you cannot complete it in one sitting. Note that the survey may include the code being valued along with other codes within the same family that are being re-valued. Do your best and fill out what you can. If the code being surveyed is not a procedure you personally perform or have not recently performed, please notify the AUA as then others can be randomly sent the survey. The link and survey cannot be shared with or sent to anyone else directly.
  2. Provide the requested contact information. This information is mainly related to your professional information. These questions are standard questions that help prevent fraud and to ensure that actual health care professionals are participating in the survey.
  3. Carefully read the description and vignette of the new or revised procedural code. It is important not to make any assumptions about what the code means or says. The new or revised code may differ from a current code or what one thinks is or is not included. When being asked about time, please estimate the time based on the details described, meaning the vignette will describe when the time clock starts at what part of the procedure (such as initial incision or insertion of a cystoscope). The vignette will also describe what is included and not included in the valuation. It is important that these details are understood when providing the data requested. Remember that time does not include services provided by technicians or other services provided on the same day that can be coded separately.
  4. Provide the information requested about the amount of time, mental effort and judgment, technical skill and physical effort, and the psychological stress that occurs during the procedure being valued. It is important to remember that you are considering a typical patient undergoing a typical procedure. You are not being asked about the easiest or hardest, fastest or slowest, or least or most complicated procedure.
  5. Compare the relative time and value of this code to a reference code. You will be provided with a list of existing procedures to use as a comparison to the code being assessed. The reference list might include CPT codes for services performed by other specialties. Select a procedure from the list provided that you believe is most similar in time, complexity, mental effort and judgment, technical skill or physical effort, and psychological stress, and compare the surveyed code to the reference code. Remember that the reference procedure and the surveyed procedure do not have to be equal in work, but rather the reference code serves as a reference point. Some aspects of the code being valued may be higher and some may be lower and some may be equal to the reference code. Use your best clinical judgment.
  6. Estimate the work RVU based on the instructions within the survey.

There may be no bigger impact that an individual provider can provide to their specialty and to organized medicine than filling out a RUC survey. If you receive a survey, don’t delete it. Fill it out!

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