How difficult it is to make 7k RVU/ y

[tartesos]

To those out there practicing, something that my fellowship sucks at teaching is billing( they all suck at it as I've heard.) so I need to ask:
I saw an offer of 350k base if you meet 7k rvu a year, how hard is that to make?
Is it true that Ccm time is about 2.5 rvu?
Thank you for your input, and any suggestions on further reading will be greatly appreciated!

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[gutonc]

Just to get you started, a straightforward, 99233 (Level 3 inpatient f/u note, the kind any IM patient in any hospital in the US should get) is worth 2.0 wRVUs. Crit care codes 99291 (30-74 minutes) and 99292 (75+ minutes) are worth 4.5 and 2.25 wRVUs respectively, in addition to the 99223. So 10 patients in your unit in a day each requiring 30-74 min of Crit Care time (otherwise, why are they still in your unit?) are worth 65 wRVUs a day. Do that 108 times a year (7000/65=107.7) and you're in business. This doesn't include procedure code billing (a tube is worth 2.3, CVC is 2.5).

So, my guess is that the answer would be "relatively easy if you stay reasonably busy".

 

[jdh71]

To those out there practicing, something that my fellowship sucks at teaching is billing( they all suck at it as I've heard.) so I need to ask:
I saw an offer of 350k base if you meet 7k rvu a year, how hard is that to make?
Is it true that Ccm time is about 2.5 rvu?
Thank you for your input, and any suggestions on further reading will be greatly appreciated!

Hard to make? Depends on what you mean by "hard". The 65 wRVU days noted above are farking busy and when I have a day like that I get home in time to go to sleep, forget warm dinner, forget seeing my kids and smoking hot wife.

However, 7000/26 = is 270 wRVUs per week worked; and 270/7 = 39 wRVU per day. Those will be busy days, and the unit needs to have the acuity to allow for the critical care billing and procedures (mostly bronchs and central lines - the rest of the procedures might as well go to IR based on how valuable your time is), but it's doable provided you are busy enough.

I am, of course assuming 7 on and 7 off

 

[tartesos]

Hard to make? Depends on what you mean by "hard". The 65 wRVU days noted above are farking busy and when I have a day like that I get home in time to go to sleep, forget warm dinner, forget seeing my kids and smoking hot wife.

However, 7000/26 = is 270 wRVUs per week worked; and 270/7 = 39 wRVU per day. Those will be busy days, and the unit needs to have the acuity to allow for the critical care billing and procedures (mostly bronchs and central lines - the rest of the procedures might as well go to IR based on how valuable your time is), but it's doable provided you are busy enough.

I am, of course assuming 7 on and 7 off

Thanks for the input guys!
That sounds doable, and they don't require much op clinic for now, so 1-2 half days should do and the rest of the time in the unit.
This is a hospital employed position( to go private later on if wanted), 26 bed Icu and no conpetition( old guys doing op) should be attainable.
The 7k rvu gets a 70k bonus.

Billing sucks btw... Just saying.

 

[gutonc]

Billing sucks btw... Just saying.

Coding (which is what I assume you're talking about) is actually pretty easy once you figure it out. The trick is figuring it out. There's no education on it in most IM or fellowship programs. If you really want to get good at it, go talk to a senior FM resident...it's a huge part of their curriculum in most programs.

 

[tartesos]

Coding (which is what I assume you're talking about) is actually pretty easy once you figure it out. The trick is figuring it out. There's no education on it in most IM or fellowship programs. If you really want to get good at it, go talk to a senior FM resident...it's a huge part of their curriculum in most programs.

I've heard from a practicing friend and I quote: " step down code to avoid Medicaid trouble", how true is this?
As long as the note meets the required billing and patient is sick enough, would it be a problem?

Thanks again all, this has been so helpful!

 

[gutonc]

I've heard from a practicing friend and I quote: " step down code to avoid Medicaid trouble", how true is this?
As long as the note meets the required billing and patient is sick enough, would it be a problem?

Thanks again all, this has been so helpful!

Oddly, undercoding is subject to the same Medicare penalties if you get audited as overcoding is. So that's not really a good solution. Of course, you're less likely to get audited if all your inpatient notes are Level 2s and outpatient are Level 3 or 4. If you work for a large employer, they're going to get audited no matter what which is why the ones (like mine) that don't pay actual coders to do your coding are idiots.

But honestly, at least in the outpatient setting for non-procedural stuff, coding is easy and there are cheat sheets everywhere to give you an idea of what and how you should bill. Inpatient coding is more complex but not that hard. If you're really freaked about it, spend a few bucks and take a weekend course (use your CME money).

FWIW, after I worked for a few months I had one of the coding auditors (they review 5-10% of cases across the institution for improper coding issues) review 30 or 40 cases with me and point out areas where I had miscoded (almost always undercoding). The reality is that one up or down-coded chart isn't going to wind you up in federal prison so try not to freak out too much about that. They're looking for patterns of (mal)practice. Don't be the guy who codes either top or bottom of every single case and you'll be fine.

 

[Hernandez]

From a more pulm side, it isn't overly difficult either. For the first 6 months of this years contract I have already billed ~4500 RVUs. This is for a mix of out patient pulm, in patient consults with some CCT on icu consults. But it isn't 7on/7off


I really wish there was a good coding and billing course, I don't trust my coders and they down code me all the damn time for some imaginary medical decision making, "what are you talking about? I'm talking about bronching the pt and that's moderate MDM?"

Don't trust your coders, buy the ACCP book and read it multiple times

 

[group_theory]

I've heard from a practicing friend and I quote: " step down code to avoid Medicaid trouble", how true is this?
As long as the note meets the required billing and patient is sick enough, would it be a problem?

Thanks again all, this has been so helpful!

I've heard the same argument too ... and at a Chest (or ATS) conference, the reply from a former auditor is "so will you take fewer deductibles when you do your taxes just so you can avoid IRS troubles?" .... the point that he (the presenter) was making as "just bill for the service you provide and properly documented and you won't get into trouble"

For outpatient (and sometimes inpatient), there are sets of rules that dictate how you bill, and medical complexity is only a small part. Whether this is a new patient (or former patient last seen 5 years ago), whether you include enough ROS, or PMH/Social/FamHx will impact

Remember that you have to make the patient look "sick enough" on paper to justify critical care time. Just because the patient needs IV Flolan and is given in the ICU doesn't necessarily mean you can bill for critical care time. Just because the patient who has DKA but is on the floor (but still on insulin gtt) does not mean you can't bill for critical care time.