Objectives: The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient. Methods:The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second-and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre-and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate.Results: The evaluation and management (E ⁄ M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second-or third-year resident was $282.82, which increased to $301.94 in the second phase (p = 0.0004). Conclusions:The educational intervention positively affected resident documentation resulting in greater RVUs ⁄ hour and greater billing performance in the study emergency department (ED). ACADEMIC EMERGENCY MEDICINE 2009; 16:423-428 ª 2009 by the Society for Academic Emergency MedicineKeywords: relative value scale, documentation, coding, education, emergency medicine S ince its creation by the Health Care Financing Administration (HCFA, now the Centers for Medicare and Medicaid Services [CMS]) in 1992, the relative value unit (RVU) has become an important measurement tool for the work performed by physicians. Each emergency physician (EP) should have a thorough understanding of this unit to appreciate its use in making comparisons between physicians in regards to work output, billing for physician services, and determining and justifying staffing needs. However, the RVU has most recently gained attention for its relation to physician reimbursement. A Schumacher Group survey of emergency department (ED) administrators found that many EPs are not well prepared for incentive-based salaries.1 To be compensated well in this setting, resident physicians must understand RVUs and proper documentation.Relative value units were developed by HCFA to construct a fee schedule for reimbursement of physician services. The total RVU has three components: the work RVUs for physician time and effort...