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  • #46




    $61 per rvu in psychiatry in Mountain West, increasing to $65 next year.
    Click to expand...


    Do you know how this is calculated? Is it a straight RVU to $ conversion?  For me its a base guarantee plus productivity incentive, that ends up to be less $/RVU the more  high you do and go above the median.

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    • #47




      Hospitalist in the midwest.  Not sure if this is how you calculate the “RVU index” but, my group pays a base salary of 240k for 1 FTE and there’s a 4000 wRVU/yr minimum that must be met.  That equates to about $60 per wRVU.  There’s a productivity bonus that doesn’t kick in until 4400 wRVUs (which is BS) and any RVUs over 4400 get paid at $26/RVU.

      I have for a long time felt that the productivity bonus system was terrible for our group because of this.  If you make up to 4399/yr, you get no productivity bonus.  Plus, 26/rvu over the threshold seems low to me.

      Does anyone else ever wonder if the whole RVU system is a major conflict of interest?  Docs in my group submit their own charges everyday.  It seems like it would be really easy to be accused of over billing in order to get a bonus each quarter.  I really don’t like this system personally.  I think a 3rd party should be submitting our charges based on our documentations.  That way we can’t get accused of trying to scam the system.
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      I would really caution relying on outside people submitting your charges based on your documentation.  Most coders really do not understand what they are looking at, and in fairness to them, they really shouldn't be expected to.  We went through 4 years of med school + 3-10 years of PG training to understand what we do.  You have someone with a non-doctorate degree and few hours of on the job training deciding what you did.  It's one of the greatest scheme by insurance carriers to increase their bottom lines.  Also 3rd party companies typically go for the lowest hanging fruit.  Because it is your bottom line, it is mor important to you to collect for the work you performed.  The CPT and ICD-10 books look overwhelming, but the reality is you need to learn about 50 codes that apply to what you do.

      I think that is one of the value added services to a practice, the physicians learning and understanding how to code.  I took it one step further and obtained my CPC.  Despite the fact that I have no knowledge of any other field of coding, I was still able to pass the test on the first try without studying (it helps that you have like 4-5 hours and it is an open book test).  I also have heard that insurance companies will purposefully underpay you (below the fee schedule amount) to see if you correct them so that they can continue to steal money from you in the future.

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      • #48


        I would really caution relying on outside people submitting your charges based on your documentation.
        Click to expand...


        While you and some docs certainly can code their own encounters correctly, IMO many have never learned and likely would be better off with a coder.  I know of several who were clearly not documenting nearly enough to warrant their E&M visit levels they submitted.

        I do think everyone should learn about it and at a minimum make sure the coders are doing a good job, it's not all that complicated really.

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        • #49





          I would really caution relying on outside people submitting your charges based on your documentation. 
          Click to expand…


          While you and some docs certainly can code their own encounters correctly, IMO many have never learned and likely would be better off with a coder.  I know of several who were clearly not documenting nearly enough to warrant their E&M visit levels they submitted.

          I do think everyone should learn about it and at a minimum make sure the coders are doing a good job, it’s not all that complicated really.
          Click to expand...


          At the very least you should take a course on specialty specific coding to at least be able to see over/under or where you are shortchanging yourself. It wouldnt take that long and directly influences your collections/time spent. You may still end up using a coding company, but in reality most only use/perform a few things, and at the very least you'd be able to check their work and spot egregious errors.

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          • #50





            I would really caution relying on outside people submitting your charges based on your documentation. 
            Click to expand…


            While you and some docs certainly can code their own encounters correctly, IMO many have never learned and likely would be better off with a coder.  I know of several who were clearly not documenting nearly enough to warrant their E&M visit levels they submitted.

            I do think everyone should learn about it and at a minimum make sure the coders are doing a good job, it’s not all that complicated really.
            Click to expand...


            I agree that most docs haven't learned.  I have probably found more that under code than over code in order to stay in their expected peer groups or not get letters from the insurance carriers reprimanding them.

            Also, with EMRs I think it would be easy to document and justify billing higher E&M codes.  E&M (criteria are from 1995 and 1997) require a "review" of certain areas.  You are not starting from scratch taking a PSH, as the patient can't have their lap chole undone and these sections can be pulled over into today's note with the click of a button.

            Like you said, we should all learn about it and it's really not that complicated.  We already know the medicine.

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            • #51
              New grad, I got an academic outpatient primary care offer at $16 an RVU for supervising resident clinic or $30ish an RVU for solo attending work.  That is flabbergasting compared to everything else in this thread.  The offer also includes a 60k guaranteed "base" salary not related to production... but oof.  Really makes you feel not valued after reading some of these numbers.

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              • #52
                We are in a 6 tier system. The RVUs are documented and collected among the group, money is put into a pot, and its split equally. Employed position, but with some private practice elements to it.

                 

                @FutureDoc Did you take the job with the $60K base pay?

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                • #53


                  $16 an RVU for supervising resident clinic or $30ish an RVU for solo attending work.
                  Click to expand...


                  That sounds bad but how many residents would you be supervising? Would you be over 3-4 residents each seeing 6 patients, which means in a 1/2 day you would be seeing about 20 patients? For a Primary care doc, that would be double what you could like see in a 1/2 day however you are making 1/2 per RVU. Also, the RVU price is low just for you as an attending too... Most academic positions are low paying but get great benefits, so you have to decide what you want.

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                  • #54
                    FutureDoc, I hope you’re still looking around, because for primary care those RVU numbers and base pay are insulting.

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                    • #55




                      New grad, I got an academic outpatient primary care offer at $16 an RVU for supervising resident clinic or $30ish an RVU for solo attending work.  That is flabbergasting compared to everything else in this thread.  The offer also includes a 60k guaranteed “base” salary not related to production… but oof.  Really makes you feel not valued after reading some of these numbers.
                      Click to expand...


                      That sounds horrific even with the best of benefits. Thanks, no thanks.

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                      • #56




                        FutureDoc, I hope you’re still looking around, because for primary care those RVU numbers and base pay are insulting.
                        Click to expand...


                        I was pretty set on the position due to academic interests... but after that I'm going to do at least 2 more interviews elsewhere in town before accepting anything.

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                        • #57
                          In Fredericksburg Virginia, private practice invasive cardiology doesn’t always pay by work RVU but I recently did a multi year analysis in our group and sadly looks like we’re limping along in the rat race at around $45/RVU.
                          This is quite lame compared to the others. I think I have to look into our staffing, overhead and accounting.
                          One note, recently two physician offices I town recently have legal action against office staff for stealing well over $100k from the practices.

                          It happens! Be vigilant.

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                          • #58
                            outpatient peds, underserved area in the Northeast.  $42/wRVU.

                             

                             

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                            • #59




                              In Fredericksburg Virginia, private practice invasive cardiology doesn’t always pay by work RVU but I recently did a multi year analysis in our group and sadly looks like we’re limping along in the rat race at around $45/RVU.
                              This is quite lame compared to the others. I think I have to look into our staffing, overhead and accounting.
                              One note, recently two physician offices I town recently have legal action against office staff for stealing well over $100k from the practices.

                              It happens! Be vigilant.
                              Click to expand...


                              We had an office manager embezzle from us... but picked it up quickly, thank goodness. Our business insurance took care of replacing the stolen fund. Unfortunately, he was the best office manager we ever had!

                              Comment


                              • #60
                                Wow, some of these wRVU numbers are astronomical, compared to my wRVU as a tele-radiologist. Currently at 28$/wRVU, will be up to 32$/wRVU as partner.  Although to be fair, I can generate anywhere from 90-110 wRVU/9 hour shift, so it may even out in the long run. The compensation ends up being decent, if you do the math on that.

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