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What you need to know about RUC and Medicare payment


A physician committee that contributes the key ingredient to the Medicare rate-setting process is under the spotlight. Are the accusations of price-fixing fair, and are there better alternatives?





Physicians who treat Medicare patients instinctively know that there’s a process involved in setting payment rates for services and a committee that’s responsible for helping Medicare complete the task. Lately, some industry observers have characterized the group-the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC)-with one of two extremes:

•    As an obscure committee that holds three boring meetings each year to do tedious evaluations that help the Centers for Medicare and Medicaid Services (CMS) set Medicare rates for physician reimbursements; or

•    As a secretive, highly politicized group that wields enormous influence over physician reimbursements-from both Medicare and private insurers-that also has conflicting interests and little oversight.

The answer might be somewhere in the middle, but it depends on who you talk to.

Click here to read more about RUC and its role in the healthcare payment puzzle.


For additional coverage, see:

Liked or loathed, RUC wields broad influence

Physician payment determinations must include more evidence

INFOGRAPHIC: How a CPT's Medicare allowable is determined

Medicare fee schedule has foothold in contracting

Current RUC members

RUC flawed but functional

RUC committee takes steps toward transparency

New payment models gain traction


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