EMG/NCS compensation

[PMRVA]

I was asked to do EMG/NCSs for an Ortho group. They already have a neurologist doing them at an outside facility. They want me to bring my machine and do them at the Ortho office. Majority of the tests would be simple CTS r/o. I think it would be beneficial to get per procedure compensation versus salary. I asked a few neurologists and they said 50% would be a good start. Any ideas on the going rate?

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[docslacker]

I do EMGs for an outside ortho group. I bring my emg machine, they supply the needles and electrodes. They do all the scheduling, billing etc. All I do is show up, do the emgs, dictate and leave. We split 50/50 on reimbursement. Works well for both us financially with no hassle.

 

[PMR 4 MSK]

Splitting the fees 50/50 may be a violation of Stark Laws. Our corporate lawyers advised against it.

Instead, if they own the machine, they get the technical component, and you get the profession compnent. You may or may not negotiate other fees and compensation including rent, overhead or personel.

If you own the machine and bring it in, legally, they can charge you rent and for staff usage, maybe even a billing fee or other admin fee. But if you supply the proessional and techinical compnent of a diagnostic test, and then plsit it 50/50, it will likely be viewed as kickback for referrals.

 

[kindredspirit]

I am in a similar position. I was asked by a Neurology practice if I wanted to come in and do EMG's in his office, likely only once a month. He says he could fill the day with, maybe 6-8 in a day. He has the machine and supplies and will handle the scheduling and billing. He just needs me to come in to perform the test and generate a report. Most cases should be on the simple side, CTS and such.

What would be a reasonable compensation to expect from this situation? Also, does anyone know the reimbursement amounts from private insurances for EMG anyway? I have a general idea of reimbursement amounts from medicare but have no idea with the private insurances. Obviously it would vary according what company-- if you could give me a ball park figure, it would be helpful!

I have to get back to the Doc soon-- any feedback is welcome!!!

 

[drusso]

I strongly echo what PMR 4 MSK has to say. The relationship you're describing can be problematic from a regulatory perspective especially if you're not paying rent.

 

[Jitter Bug]

Reimbursement per EMG varies by region and by the contract you sign with your payors. It's hard to even give you a ballpark because of that. Start with medicare dollars when you make your estimates, because you will probably make more from your private payors, but it may take a few months of actual payments to find out how much more. The CMS data is all on the website.

My arrangement is I collect the professional fees and my facility (which provides the reception staff, room, machine and equipment) takes the facility fee.

This is a pretty common setup if all you do is walk in and do the study.

 

[Louisville04]

Reimbursement per EMG varies by region and by the contract you sign with your payors. It's hard to even give you a ballpark because of that. Start with medicare dollars when you make your estimates, because you will probably make more from your private payors, but it may take a few months of actual payments to find out how much more. The CMS data is all on the website.

My arrangement is I collect the professional fees and my facility (which provides the reception staff, room, machine and equipment) takes the facility fee.

This is a pretty common setup if all you do is walk in and do the study.

Does this cost the patient more than if you did it in your office (similar to doing procedures in ASC vs office).

 

[bedrock]

Does this cost the patient more than if you did it in your office (similar to doing procedures in ASC vs office).

An office is an office, unless it's considered part of a hospital.

Your patients and their insurance pay more for a EMG performed at a hospital.

 

[kindredspirit]

Thank you all for your responses. I'm still stumped. I appreciate your heads up that the 50/50 arrangement could be at risk of violating the stark laws, especially if I will not be paying rent, which I won't be. So, being that neither he nor I, wish to be violating any such laws, how shall we proceed in making this work, both legally and financially? He's a busy Neurologist, needs help, asked me to do some EMG's, a full day/month. I have no idea what reimbursements are here-- I'm in California. And, Jitterbug, what is the CMS data and where shall I find that?

I'd like to just give him a number or a % and then ask him to run it past his practice's atty.

Any other advice?

 

[lobelsteve]

Thank you all for your responses. I'm still stumped. I appreciate your heads up that the 50/50 arrangement could be at risk of violating the stark laws, especially if I will not be paying rent, which I won't be. So, being that neither he nor I, wish to be violating any such laws, how shall we proceed in making this work, both legally and financially? He's a busy Neurologist, needs help, asked me to do some EMG's, a full day/month. I have no idea what reimbursements are here-- I'm in California. And, Jitterbug, what is the CMS data and where shall I find that?

I'd like to just give him a number or a % and then ask him to run it past his practice's atty.

Any other advice?

Get a flat fee per day for showing up and that's it. Don't think about revenue generated, think about what would make you happy for the day doing EMG/NCV. If your happy number matches his livable number in paying you as a 1099, then you go to work.

 

[DelawareDoctor]

Need EMG/NCV per diem doctor for Delaware practice. If interested, please call 302-439-3063. 30 minutes from Philly.

 

[Jitter Bug]

Jitterbug, what is the CMS data and where shall I find that?

QUOTE]

It's convoluted. Go to CMS page, select yellow medicare link from top banner. Under the "fee for service payment" section, select "physician fee schedule look up". under that, select the "start" button to lookup by CPT code. Enter your code and parameters and CMS spits out RVU and fee data. You can look up your most commonly used EMG CPT codes here to get some ballpark info. You can sort by physician fee and technical fees too.

it's under HCPCS codes FYI. same as CPT.

 

[lobelsteve]

Need EMG/NCV per diem doctor for Delaware practice. If interested, please call 302-439-3063. 30 minutes from Philly.

Need an MD/DO ***** for a chiro. No patient care required. Looking to generate tons of revenue for the owner and screw you out of as much as possible. Lack of skills a plus as we are looking for abnormal studies due to technical artifact. Most cases are Medpay from MVA. We are stripping the PIP. Remainder of cases are for suspected DM neuropathy.

 

[Jitter Bug]

Need an MD/DO ***** for a chiro. No patient care required. Looking to generate tons of revenue for the owner and screw you out of as much as possible. Lack of skills a plus as we are looking for abnormal studies due to technical artifact. Most cases are Medpay from MVA. We are stripping the PIP. Remainder of cases are for suspected DM neuropathy.

 

[Paddington]

Instead, if they own the machine, they get the technical component, and you get the profession compnent. You may or may not negotiate other fees and compensation including rent, overhead or personel.

Let's say you get hired by a PM&R practice to do outpatient physiatry. When you do EMG's, will they bill by the global code or break it up into technical and professional components?

I'm asking because that would strongly affect your threshold bonus (which is how things are structured nowadays). If the global fee is applied towards your revenues, then that's substantially more than just the professional component would be. And contracts I've seen don't seem to specify how things get billed (although they have pages and pages of other stuff). Are there any rules regarding this?

 

[PMR 4 MSK]

Let's say you get hired by a PM&R practice to do outpatient physiatry. When you do EMG's, will they bill by the global code or break it up into technical and professional components?

I'm asking because that would strongly affect your threshold bonus (which is how things are structured nowadays). If the global fee is applied towards your revenues, then that's substantially more than just the professional component would be. And contracts I've seen don't seem to specify how things get billed (although they have pages and pages of other stuff). Are there any rules regarding this?

That should be negotiated and put in writing. I've learned that the hard way also. Within your own practice, you can do it many ways. Private insurance companies often will not seperate PC and TC, and will only pay flat fee. You then have to decide how you will divide it with your employers. You can go %, flat fee or some hybrid.