Jump to content

Recommended Posts

Recently our compensation structure changed to RVU’s with reduction in base salary. At the end of the year however (based on performance) portion of salary reduced can be earned as a “bonus” If certain metrics are met. 

Currently I see inpatients only. All billing  previously   were done by separate dept. Recently it was  realized codes submitted  adjusted by the billing dept(Not sure if this is allowed). I am also not sure if my patients are billed with my NPI, or under my supervusing physician’s.

I am trying to increase my understanding to take the corrective steps and ask the right questuons. I have seen a few very informative post

Any additional suggestions, input ,seminars, webinars I can be referred to would be helpful.

 

Link to post
Share on other sites
  • 2 months later...

CPT codes will be adjusted by your billing department. This is why they exist. If you code incorrectly, they will correct your codes so that the claim does not get denied. They may also find CPT's that you did not, and increase reimbursement. 

It may be billed under your NPI, or it may be billed under the doctor's. Some insurances will not recognize your NPI and it has to be billed under the doctors. This is not important in the realm of who did the visit. 

The questions you probably need to ask are, "Where can I view my statistics?" 

This is a very fair question, as when you have more RVU's, you are being paid more to make more money for your business. (ie: everyone wins)

  • Upvote 1
Link to post
Share on other sites

There are CPT codes, E/M codes, and billing modifiers.  CPT codes are for procedures, E/M codes are for an actual patient visit (inpatient, outpatient, etc.), and billing modifiers can increase billing value (i.e. hip replacement more difficult than normal because of broken hardware).  In general the billing department can correct CPT codes, but there is still a process to follow.

E/M codes on the other hand (for outpatient: 99213, 99214, 99215) that is established by the provider who sees the patient and can only be changed by said provider or a CERTIFIED CODING SPECIALIST - most billing departments do not have these, but some I'm sure do - a hospital organization may have some on hand, I don't know.  But a normal "billing person" does not have the authority to change E/M codes.  See the link pasted below.

Billing modifiers: don't know enough to really comment, but would assume it is similar to E/M codes, but again I don't know.

https://www.medscape.com/viewarticle/872465 

 

To give an example (I work in outpatient FM): I see a patient for HTN followup who also has knee pain and depression.  Assuming I do an appropriate visit this is almost 100% guaranteed to be a 99214 (E/M code), but there may be CPT codes used along the way for a possible knee injection (20610) with a billing modifier of 25 (that's what I've been told to do, but again don't know tons about these).

 

In FM, the vast majority of my RVUs are from "simple" patient visits and therefore the E/M codes, but of course I do office procedures sprinkled in (CPT codes).  Bottom line, if you are paid on production, you should have 100% access to your numbers and should know the specifics of any E/M codes that are being changed (whether by a certified coding specialist or otherwise).  I am actually changing jobs in large part because my current employer has been actively changing my E/M codes illegally and I am seriously considering reporting them and hiring an employment lawyer, both to recoup the lost bonus income, but also to protect myself as this is blatant fraudulent behavior.

  • Upvote 1
Link to post
Share on other sites
On 12/11/2018 at 1:11 PM, mgriffiths said:

I am actually changing jobs in large part because my current employer has been actively changing my E/M codes illegally and I am seriously considering reporting them and hiring an employment lawyer, both to recoup the lost bonus income, but also to protect myself as this is blatant fraudulent behavior.

Sorry to hear this.

What's the rationale for employer to change your codes to a lesser value? Don't you both lose in that scenario? 

  • Upvote 1
Link to post
Share on other sites

Yes they do lose income.  It's a long story, but the bottom line is that they also have the ability to calculate my RVUs based on the downgraded billing, and then re-bill the insurance companies with the appropriate billing - this effectively decreases my income while they don't lose anything (assuming they are successful with the insurance companies).

Basically it all started with billing making an error in changing my billing and administration is trying to cover the tracks.  Of course that doesn't explain why it has continued, but I believe that is because I caught the issue and made it clear to them it was illegal.  Furthermore, once I resigned they are trying to keep every dollar they can.  There's more to it, but it gets convoluted.

  • Upvote 1
Link to post
Share on other sites
  • 2 months later...

This topic on RVU’s were initially posted in September 2018. Took me some time to revisit. I am now seeing the responses as they were not immediate.

Very glad I did however.  These are all very helpful in gaining better understanding of the wRVU approach.

It has been quite confusing Changing from salary base to partially  RVU. It is a convoluted journey. However if it is becoming the wave of the future, best we all understand it.

As for my situation very similar to post by Mgriffiths. I billed encounters based on codes provided to use atvtime of higher( RVUs were not used at that time as part of compensation)

Once the change was made it was realized codes were not appropriate for patient encounters.

Very helpful information. I will look at the medscape video as well. Not sure of the roadblocks I will encounter. But after reading the responses, I certainly have questions. 

 

 

 

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Similar Content

    • By roemen2
      Does anyone have any good CME or other educational references to help me expand my knowledge of billing/coding?  I do family practice with ER/hospital coverage in a rural health facility. Clinic is my main concern as the hospital charges are all reviewed by the coders. Thanks!
×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More