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Greetings, friends and colleagues. Welcome to the new year and happy New Year. Let’s talk about, and I warned you last month there was gonna be changes in there are, we’re gonna talk about what’s gone on with relative value units and how they’re gonna affect our reimbursement. So let’s go to the slides.
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Let’s talk about what is gonna be happening for 2026 with relative value. Units. Let’s remember, relative value units are those fees or values that are set up for code that tell us what the code is worth, but not only what it’s worth, but what it’s worth compared to other services. So relative value units are used by all carriers.
Maybe not a SHI mean, they’re, they’ve got their own thing going. But for most carriers, of course, everything is tied to the relative value unit or RVU. This includes things like Medicare, of course, Medicare rates are set specifically from that. The same of Polar applies to the va, workers’ comp, personal injury and health insurance for that matter.
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But where the difference is understanding how do we use relative values for conversion and how do they help or hurt us? Every year of course, these do make a value change, and for this year they did make changes as well. Now, the interesting thing is some of the fees or. Relative values went down slightly, but yet the fees remain the same.
You think how does that happen? How did the fees remain the same? Because the value changer, what we multiply, did increase. However, some did increase quite a bit. So let’s take a look at what did happen. With relative values for this year. So you can look at this list and go Sam, it doesn’t mean a whole lot to me.
What’s been the change here? So let’s look specifically at some specific services. Obviously for chiropractors, we care about manipulation. So if you look at 9, 8, 9, 4 oh and four one, you’re gonna go, Hey, wait a minute, Sam. 9, 8, 9, 4 oh. Went from 0.8, or excuse me, 0.82 to 0.8. So it went down 2%. Or 9, 8, 9 4, 1 went down 4% and you’re thinking, oh my God, that went down.
In reality, 9, 8, 9 4 3 stayed the same. So you may look and go did that mean I get a decrease in fee? Actually not. What I do wanna make important here though, is I want everyone to see the difference between a four oh and a 4 0 1 is still 35%. So do make sure that you don’t have a fee for 9 8 9 4 oh.
Then one for a four, one that’s only $10 higher, it’s gotta be about 35% higher. Now, here’s where there’s been a big change. There’s about a 4% increase when we look at e and m codes. So you’ll notice 9 9 2 0 3 is a 3.52. It was 3.37. So it’s interesting. There’s an increase in the ratio that codes are paid.
We had a 3% increase by Medicare, but when you look at it, if there was a 3% increase in the conversion. A 2% in decrease in the conversion factor. What does that mean? Flat, not, we get a little bit more, the big difference, of course, is for e and m codes, and you may think Sam, is that really gonna affect me much?
It could in this way. I will tell you, adjustment codes, as far as Medicare’s concerned in the VA are about the same. But do remember these fees are used with multipliers for all different types of things. By example, in Michigan. Florida, their personal injury is 200% of Medicare, so you just take Medicare rates by 200%.
Or for California work comp is 150. And I will say for most of you, your fees generally should be at least one and a half times Medicare. So by example, you’ll notice in Arizona they use a multiplier. This is for workers’ comp. It’s $69. Now the standard Medicare conversion is right about 35, so this is more than double that.
Idaho, it’s 49 Maryland, 51, Texas, even more 70. Now, not every state uses this, at least formally in this way, but they do in this manner. Every state is gonna use relative values to set fees. So you wanna start to make sure, do my fees make sense? So if we go back here, if you notice, 9, 9, 4, oh being valued at a 0.8.
9 9 2 0 3 at 3.52. Eight times four is 32. So when you look at, if it’s 3.5, wouldn’t that mean that your fee for an exam should be roughly a little more than four times the rate for the adjustment? So if you’re charging 50. For a 9, 8, 9 4, oh. What should be your fee for a 9 9 2 0 3? Roughly four times that if you’ve not raised it, you’re losing money.
’cause that’s exactly how these are broken down. So you wanna make sure that you’re using the new RVs to say, okay, just because my rates for manipulation may have been flat with a conversion, do I need to increase others by example? Some therapy fees went up a couple of percent. Here’s the general rule.
When you’re starting the new year, should you be looking at adjusting your fees? Yes, a little bit. Cost of living. If nothing else, even Medicare did 3%. So I would say everyone should be up about 3% of that rate. Realize the actual amount for Medicare is 3.26 and you’re gonna go Sam, if they lowered it two and raised it, 3.26.
That means I’m zeroed out. Not quite. You should see for most of you, there’s been a little bit of an increase. Don’t get excited. It’s not a terribly high increase, but an increase. Nonetheless, if you’ve not attended one of my seminars where we go over these in detail or you’re a network member, of course reach out to me because we wanna make sure, do you have the correct fees and more important.
What about the ratio based on other services? Many of you are undervaluing your e and m codes, and of course re-exams may not be every visit, but certainly that’s a substantial amount of revenue for many. And I’ll give an example. I had a person this morning that was literally charging $80 for an exam that’s 40% below Medicare.
Yet they were charging 200% for another code. You wanna start to look through and allow RVU to allow you to make that adjustment. That’s what we do for you network members. You’ve gotta reach out to me. Let’s get a Zoom meeting going or make sure come to our seminars January 17th and 24th. We will give everyone attending a full list of your Medicare rates and how that converts to work comp and others to make sure don’t lose revenue in 2026 ’cause there has been increases.
Until next month, my friends hope you stay at a seminar, but I’ll see you next time.
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