RVU based compensation- Work RVU Vs Professional Component.

[neuro kid]

I am a fresh out of school neurologist and work for a hospital on a RVU based compensation structure. I am trying to figure out what I should be getting for a given procedure- say a motor nerve conduction study- CPT 95903.

The hospital has created an EMG lab (The hospital pays for the machine, technician salary, and the other technical expenses including malpractice insurance). I oversee the activities of the technician, and interpret the study.

The hospital bills the insurance companies for the total RVU value of a procedure (eg 95903) at 1.76 X conversion factor. My question is, how many RVUs should they pay me as the physician in charge of the lab?
Should it be:
A: PC- Professional Component= 0.83, or
B: PW- Physician Work= 0.60

It seems like the federal register only gives out values for the Physician Work element, and there is no mention of the PC in the tables at the end of their document.
Could someone help me understand the basic difference between PC and PW, along with which one I deserve for interpreting and overseeing a NCS?

I will attach two links for documents that are supposed to govern these issues:
- AAN Medicare fee structure(Pg 9/17) http://www.aan.com/globals/axon/assets/6506.pdf

- The 2009 Federal Register (Very large document- 15MB, go to page 33793 for reference)- http://edocket.access.gpo.gov/2009/pdf/E9-15835.pdf

---

Members don't see this ad.

 

[Ludicolo]

I am a fresh out of school neurologist and work for a hospital on a RVU based compensation structure. I am trying to figure out what I should be getting for a given procedure- say a motor nerve conduction study- CPT 95903.

The hospital has created an EMG lab (The hospital pays for the machine, technician salary, and the other technical expenses including malpractice insurance). I oversee the activities of the technician, and interpret the study.

The hospital bills the insurance companies for the total RVU value of a procedure (eg 95903) at 1.76 X conversion factor. My question is, how many RVUs should they pay me as the physician in charge of the lab?
Should it be:
A: PC- Professional Component= 0.83, or
B: PW- Physician Work= 0.60

It seems like the federal register only gives out values for the Physician Work element, and there is no mention of the PC in the tables at the end of their document.
Could someone help me understand the basic difference between PC and PW, along with which one I deserve for interpreting and overseeing a NCS?

I will attach two links for documents that are supposed to govern these issues:
- AAN Medicare fee structure(Pg 9/17) http://www.aan.com/globals/axon/assets/6506.pdf

- The 2009 Federal Register (Very large document- 15MB, go to page 33793 for reference)- http://edocket.access.gpo.gov/2009/pdf/E9-15835.pdf

Global charges consist of a professional component (PC) and a technical component (TC).

The basic difference between the PC and physician work (PW) is that PW is included in the PC. Also included in the PC are any overhead expenses and professional liability insurance associated with the interpretation of diagnostic testing, in this case NCS/EMG. Sounds like the hospital is handling the TC. When you say the hospital is covering expenses/malpractice, is that for both the physician (which would come under PC) and the EDX tech (which would come under the TC)? If the hospital is covering your overhead and malpractice, then probably what's left from an RVU pay rate standpoint is the PW.

Caution: if you use a tech in the hospital setting, you yourself can't bill for the TC. You could only bill for the PC. Unless you perform the NCS yourself, or the tech is directly employed by you (not the hospital), or you own the EMG machine. Medicare regulations and all that.

Question: will you be performing needle EMG, in addition to supervising the EDX tech? Because there you can bill for both the PC and the TC.

Edit: and as an aside, this will probably get moved out of the general residency forum. Maybe move this to the EMG forum?

 

[NotAProgDirector]

A great answer by Ludicolo. In the OP's case, the answer is "whatever your contract states", which is probably the PW component.

 

[JackADeli]

OK, so the lowest compensation/RVU is somewhere in the range of ~$31/RVU... this would be medicare reimburse for FM services. The question is what your base clinical compensation is and what amount of RVUs you must achieve for "trigger" to bonus compensation/RVU. I dare say, in general, you should be shooting for a greater then $41/RVU compensation and if a high end specialty, greater the $55/RVU compensation after "trigger"...

But, as mentioned, it all comes down to what your contract is, what your clinical base is, hat your "payer mix" (i.e. private insure vs medicare) is, what your trigger is, etc...... Also, are you hospital employed vs private employed... makes a difference. Latest data suggests hospital employed gets more per RVU....