Looking for someone to explain the business of emergency medicine!

[MechEDoc]

Long time lurker, infrequent poster. I am an emergency physician that works in a environment where I have no understanding of what is charged on my behalf or the cash flow of emergency department. I'm a pretty typical emergency medicine physician who sees 2 to 2.5 patients per hour.

Given a typical mixture patients in a community setting, appropriately documented encounters, reasonable critical care documentation, a normal mix of procedures and a typical admission rate of ~15%...

How big is the pie and how is it sliced?

What are typical RVUs per hour in this scenario? What is the typical reimbursement per RVU (average reimbursed with a typical payor mix)? How much of this goes to the CMG? How much to payroll? Insurance?

If doing locums - how much overhead is there?

How much does credentialing usually cost? Does the hospital bear this in overhead or does it charge back to the EM group?

Somewhat unrelated - if one is forced to sign a chart but only attests that they were in the department but not involved in the care of a PA's or NP's patient - do most patient's get billed at 85% or 100%?

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[bravotwozero]

Look for the thread called how much are you really worth, very insightful, though doesn’t answer everything you’ve asked.


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[MechEDoc]

Read the whole thing. That's what really got my interest going. I'm aware of the RVUs/pt, the variable "exchange rate" of RVUs to USD (self pay / no pay, gov't "insurance", and private insurance). Kind of curious about how it all breaks down. I've heard people stating that professional fees range from $400 to $1k+/hour. I kind of think it must be somewhere in between and very payor mix dependent. I've also heard really variable things about locums overhead...

 

[Janders]

Well we can't answer without opening your books and seeing for ourselves...

You see 2.25pt/hr, admit 15%, chart well, bill well, have a "generic" population of insured / medicare /medicaid split and live in a state with a generic level of payment?

My crystal ball says you generate $350/hr of professional revenue [you are "billing" for much more than that], without ANYTHING being pulled out of it. +/- $100/hr This WILL vary by area, and especially by payor mix, and by skill of billers and coders.

Overheads include--
coding
billing
group admin
scheduling
HR / Corporate functions
Credentialing
The rest goes to "you" but you might not consider the money used to cover your medical, dental, ocular, umbrella, malpractice, and disability insurance to be "yours" but instead overhead. As well the "matching" or "employer" side of retirement contributions...
Then salary and "bonus" money

**
This is NOT counting any money created by the NPs/PAs you are cosigning during that same time. It is highly dependent on the insurance and the level of your attestation whether 85% or 100% will be billed and collected.\
And of course you have to balance this with the cost of the PAs/NPs which I didn't list in the overhead area...
**

Anyway, you can ask around and see if people will tell you the costs for their shop listed above.
But I would posit the only way to know if you are getting a "fair" deal is to have your own books open to your perusal.
You can use as a proxy if your take home hourly + benefits + bonuses = similar to other similar jobs in your area... but that doesn't tell the entire story.

 

[EctopicFetus]

If you work for a CMG and their shady business practices they are probably collecting $200 per patient. So if you are seeing 2.25 your employer is collecting 450/hr. The assumption of collections of 350/hr would be a more typical SDG who is required to contract with all. Reality is that this number varies greatly based on your payer mix, what Medicaid pays in your state etc.

In AZ Medicaid paid 105% of Medicare. In TN it is closer to 70%. Medicaid patients make up at least 25% of your volume.

Coding and billing is between $5 - $10 per chart.
Scheduling can be done very cheaply.
Credentialing is pretty close to $0
Med mal is another thing which is state dependent. Think about 20k per year but some states are closer to 50k.

Hospitals who employ their docs tend to be terrible at EM billing and coding.

 

[EctopicFetus]

PM me if you want to chat more.

 

[deleted547339]

Think about a pimp and a hooker.

 

[thorg12]

Ectopic,
In ariozona Medicaid pays 105% of Medicare?!
In PA I want to says it’s like 25%
Level 5 chart says 50$
http://www.dhs.pa.gov/publications/forproviders/schedules/outpatientfeeschedule/index.htm

 

[EctopicFetus]

Ectopic,
In ariozona Medicaid pays 105% of Medicare?!
In PA I want to says it’s like 25%
Level 5 chart says 50$
http://www.dhs.pa.gov/publications/forproviders/schedules/outpatientfeeschedule/index.htm

Yes.. in Arizona when i was there a while back it was 105% of Medicare. Smart for the state to do since much of the money comes from the feds.

 

[bravotwozero]

Since we're on the subject, can someone kindly explain how RVUs work in terms of midlevel supervision? Do you both get rvu credit, or is just the midlevels? Are the RVU payments for #patient/hr of midlevel supervision the same as if you had seen them on your own without midlevel assistance?

 

[deleted859535]

Since we're on the subject, can someone kindly explain how RVUs work in terms of midlevel supervision? Do you both get rvu credit, or is just the midlevels? Are the RVU payments for #patient/hr of midlevel supervision the same as if you had seen them on your own without midlevel assistance?

CMS rules are such that you can bill 85% for MLPs seeing without an attending seeing at bedside; 100% if both. As for the credit, my understanding is that this is a bit group/employer/situation-specific. Often, groups will have the RVUs captured go to the attending if the latter situation above but still log RVUs on a per-MLP basis for productivity considerations for the midlevel.

I'm sure there are a lot of details in the whole thing I could use a better understanding of myself.

 

[Mbekweni]

.

 

[deleted859535]

Our private group collects about 31-33% of total charges per patient for a total collection of $185-195 per patient on an average month given our patient mix. Insurance rates have squeezed that collection ratio down a few percentage points over the years. Compared to the thread referenced above I think we are actually doing pretty well as the suggested national average was around $150 /pt. We are a bit slow, mainly overnight at around 1.1 pph, during the day up around 1.7-2+ (doc average of 1.6 pph or so overall). It works out to an hourly of around $190 per hour plus partnership bonus of 20-23% after working for a few years. If we had more volume $/hr would likely go up substantially but it's a pretty relaxing work environment at that pace and good for career longevity. The nice part about not having to do the $/rvu which I have done with large CMG is that can be manipulated easily. Private group with just a share of the pie minus administrative expenses with open financial books seems more straightforward to me and I'm happy with the current arrangement. Our medicaid reimbursement is terrible, and is the main drag on our reimbursements aside from patient volume. Contrary to everything that I have heard around the house of medicine, our uninsured patients pay between 50%-75% of charges depending on the month for a better reimbursement rate than private insurance! I guess it's a local culture of paying your dues and debts. Also lawsuit rate is 1/3 that of the state average. Nice little community.

I'd be curious to hear what other people are getting. The $/hr figure are very misleading as they don't account for volume, acuity etc. Only slightly better than $/year where there is no way to distinguish the doc working 20 shifts a month from the part timer (ie in the Medscape physician compensation surveys).

I'm with you on the preference for a more SDG-style, income versus cost model. Same here.

Willing to share at least the region you're in? Always interested what things are like across the country.

 

[EctopicFetus]

CMS rules are such that you can bill 85% for MLPs seeing without an attending seeing at bedside; 100% if both. As for the credit, my understanding is that this is a bit group/employer/situation-specific. Often, groups will have the RVUs captured go to the attending if the latter situation above but still log RVUs on a per-MLP basis for productivity considerations for the midlevel.

I'm sure there are a lot of details in the whole thing I could use a better understanding of myself.

Be very careful distinguishing between billed charges, collections and reimbursed rates.

CMS has no control over what you can bill. CMS pays 85% of their allowable if it is a PA only case. Most insurance companies and Medicaid pay the same though in Alabama BCBS started with the 85% nonsense and I think TN is lining up to follow for BCBS.

Regarding the credit that is internal to the group.

 

[deleted859535]

Be very careful distinguishing between billed charges, collections and reimbursed rates.

CMS has no control over what you can bill. CMS pays 85% of their allowable if it is a PA only case. Most insurance companies and Medicaid pay the same though in Alabama BCBS started with the 85% nonsense and I think TN is lining up to follow for BCBS.

Regarding the credit that is internal to the group.

Thanks, poor terminology on my part. OP, that^ -- reimbursement as Ectopic mentioned.

 

[Birdstrike]

Long time lurker, infrequent poster. I am an emergency physician that works in a environment where I have no understanding of what is charged on my behalf or the cash flow of emergency department. I'm a pretty typical emergency medicine physician who sees 2 to 2.5 patients per hour.

Given a typical mixture patients in a community setting, appropriately documented encounters, reasonable critical care documentation, a normal mix of procedures and a typical admission rate of ~15%...

How big is the pie and how is it sliced?

What are typical RVUs per hour in this scenario? What is the typical reimbursement per RVU (average reimbursed with a typical payor mix)? How much of this goes to the CMG? How much to payroll? Insurance?

If doing locums - how much overhead is there?

How much does credentialing usually cost? Does the hospital bear this in overhead or does it charge back to the EM group?

Somewhat unrelated - if one is forced to sign a chart but only attests that they were in the department but not involved in the care of a PA's or NP's patient - do most patient's get billed at 85% or 100%?

The answer to all of your questions, is somewhere in this equation

(Charges billed x Collection %) - Expenses, including admin's cut = Dollars available to pay EPs

 

[bravotwozero]

Regarding the credit that is internal to the group.

So in your experience, does your individual RVU reimbursement suffer if you yourself were to see less patients/hr, but the ones you didn't see alone were seen under midlevel supervision?

 

[BAM!]

California medicaid physician reimbursement looks better than PA. $108 for a level 5 chart.

N 99281 EMERGENCY DEPT VISIT 14.60 $15.18 --- $15.18 017 1 0 0.00 $0.00 Y
P 99281 EMERGENCY DEPT VISIT 12.61 $10.34 --- -- 019 0 0 0.00 $0.00 Y
P 99282 EMERGENCY DEPT VISIT 23.42 $19.20 --- -- 019 0 0 0.00 $0.00 Y
N 99282 EMERGENCY DEPT VISIT 23.44 $24.38 --- $24.38 017 1 0 0.00 $0.00 Y
N 99283 EMERGENCY DEPT VISIT 42.88 $44.60 --- $44.60 017 1 0 0.00 $0.00 Y
P 99283 EMERGENCY DEPT VISIT 42.83 $35.12 --- -- 019 0 0 0.00 $0.00 Y
P 99284 EMERGENCY DEPT VISIT 65.65 $53.83 --- -- 019 0 0 0.00 $0.00 Y
N 99284 EMERGENCY DEPT VISIT 65.72 $68.35 --- $68.35 017 1 0 0.00 $0.00 Y
N 99285 EMERGENCY DEPT VISIT 103.92 $108.08 --- $108.08 017 1 0 0.00 $0.00 Y
N 99291 CRITICAL CARE FIRST HOUR 12.16 $121.60 $132.67 $151.03 001 1 0 0.00 $0.00 Y
N 99292 CRITICAL CARE ADDL 30 MIN 5.89 $58.90 $64.26 $73.15 001 1 0 0.00 $0.00 Y


I tried looking up the Medicare physician fee schedule for a 99285 chart. I spent an embarrassing amount of time running in circles. Can anyone find or make sense of this fee schedule online?

 

[EctopicFetus]

So in your experience, does your individual RVU reimbursement suffer if you yourself were to see less patients/hr, but the ones you didn't see alone were seen under midlevel supervision?

In my job the MLPs see their own patients. Unless they have a question I dont see their patients. So it has no effect on me. They are a profit center who sees patients I dont want to (fast track).

 

[EctopicFetus]

California medicaid physician reimbursement looks better than PA. $108 for a level 5 chart.

N 99281 EMERGENCY DEPT VISIT 14.60 $15.18 --- $15.18 017 1 0 0.00 $0.00 Y
P 99281 EMERGENCY DEPT VISIT 12.61 $10.34 --- -- 019 0 0 0.00 $0.00 Y
P 99282 EMERGENCY DEPT VISIT 23.42 $19.20 --- -- 019 0 0 0.00 $0.00 Y
N 99282 EMERGENCY DEPT VISIT 23.44 $24.38 --- $24.38 017 1 0 0.00 $0.00 Y
N 99283 EMERGENCY DEPT VISIT 42.88 $44.60 --- $44.60 017 1 0 0.00 $0.00 Y
P 99283 EMERGENCY DEPT VISIT 42.83 $35.12 --- -- 019 0 0 0.00 $0.00 Y
P 99284 EMERGENCY DEPT VISIT 65.65 $53.83 --- -- 019 0 0 0.00 $0.00 Y
N 99284 EMERGENCY DEPT VISIT 65.72 $68.35 --- $68.35 017 1 0 0.00 $0.00 Y
N 99285 EMERGENCY DEPT VISIT 103.92 $108.08 --- $108.08 017 1 0 0.00 $0.00 Y
N 99291 CRITICAL CARE FIRST HOUR 12.16 $121.60 $132.67 $151.03 001 1 0 0.00 $0.00 Y
N 99292 CRITICAL CARE ADDL 30 MIN 5.89 $58.90 $64.26 $73.15 001 1 0 0.00 $0.00 Y


I tried looking up the Medicare physician fee schedule for a 99285 chart. I spent an embarrassing amount of time running in circles. Can anyone find or make sense of this fee schedule online?

 

[EctopicFetus]

1 RVU pays $35.99 in 2018 for medicare.

 

[Alvarez13]

View attachment 229641

1 RVU pays $35.99 in 2018 for medicare.

Thank you so much for this.

I work in an ER where I'm the only attd and I supervise 3 PAs. 2 do the fast track side (I barely see them, just sign their charts) and 1 works with me on the high acuity side. My admit rate is ~75% and almost all are level 5, long obs, or critical care charts.

Thus, for a 10 hr shift: 1.8 pts/hr x $36/RVU x 5 RVU/pt = 323.81/hr.
Meanwhile, as locums I'm at $285/hr, maybe closer to $300/hr with all the hotel/rental car fees. This doesn't seem like much of a profit for the hospital. I'm sure my locums dude is getting some amt too.

If you do the math at 6 RVUs/pt (maybe close to this as I do a lot of CC), it bumps it up to $388/hr, but still, doesn't seem like a lot. I'd figure if the hospital is paying me $300/hr, they'd be making like $600/hr. Am I missing something?

 

[Hercules]

Thank you so much for this.

I work in an ER where I'm the only attd and I supervise 3 PAs. 2 do the fast track side (I barely see them, just sign their charts) and 1 works with me on the high acuity side. My admit rate is ~75% and almost all are level 5, long obs, or critical care charts.

Thus, for a 10 hr shift: 1.8 pts/hr x $36/RVU x 5 RVU/pt = 323.81/hr.
Meanwhile, as locums I'm at $285/hr, maybe closer to $300/hr with all the hotel/rental car fees. This doesn't seem like much of a profit for the hospital. I'm sure my locums dude is getting some amt too.

If you do the math at 6 RVUs/pt (maybe close to this as I do a lot of CC), it bumps it up to $388/hr, but still, doesn't seem like a lot. I'd figure if the hospital is paying me $300/hr, they'd be making like $600/hr. Am I missing something?

Yes. You’re missing the facility fee plus the money they make off of every lab test and imaging study that you do. This other money absolutely dwarfs your professional fee. That’s why freestanding ED‘s can see very few patients and still be very profitable.


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[EctopicFetus]

Thank you so much for this.

I work in an ER where I'm the only attd and I supervise 3 PAs. 2 do the fast track side (I barely see them, just sign their charts) and 1 works with me on the high acuity side. My admit rate is ~75% and almost all are level 5, long obs, or critical care charts.

Thus, for a 10 hr shift: 1.8 pts/hr x $36/RVU x 5 RVU/pt = 323.81/hr.
Meanwhile, as locums I'm at $285/hr, maybe closer to $300/hr with all the hotel/rental car fees. This doesn't seem like much of a profit for the hospital. I'm sure my locums dude is getting some amt too.

If you do the math at 6 RVUs/pt (maybe close to this as I do a lot of CC), it bumps it up to $388/hr, but still, doesn't seem like a lot. I'd figure if the hospital is paying me $300/hr, they'd be making like $600/hr. Am I missing something?

You are also mine massive profit from the MLPs. Oh and fracture care, reading ekgs etc. Also, depending on the payer mix it might be more than that for an RVU (on average).

Lastly, locums usually make way more than most and as such they are making more profit off the others. That being said consider the MLPs.. One doc at 285/hr and 3 MLPs at 80-100/hr.. they are making plenty.. As Hercules said don’t forget the facility fee, profits off of admissions etc.

 

[BAM!]

View attachment 229640

What is Work, PE, and PLI?

 

[EctopicFetus]

What is Work, PE, and PLI?

RBRVS FAQ // ACEP

The RBRVS incorporates three components of physician services - physician work, practice expense, and professional liability insurance (PLI).

 

[Arcan57]

In regards to MLPs, they bill at either 85% or 100% depending on your involvement. This billing is collected by whoever is employing them. If you are in an RVU model with a CMG then if you sign the chart you get the RVUs as if you had seen the patient. The MLP may get a straight hourly, RVU only, or a mix. So it seems like the CMG is paying twice for each RVU generates by an MLP. That’s where the RVU multiplier comes in. The CMGs have a very good idea of how productive their MLPs will be, so they set the multiplier such that you get paid less for each RVU then if there were no MLPs. This incentivizes getting involved in MLP care since their RVUs go to you. In reality, you’re still making what you were going to make if you play along. If you work a shift that doesn’t have MLP charts to sign, watch your income crater.

 

[EctopicFetus]

In regards to MLPs, they bill at either 85% or 100% depending on your involvement. This billing is collected by whoever is employing them. If you are in an RVU model with a CMG then if you sign the chart you get the RVUs as if you had seen the patient. The MLP may get a straight hourly, RVU only, or a mix. So it seems like the CMG is paying twice for each RVU generates by an MLP. That’s where the RVU multiplier comes in. The CMGs have a very good idea of how productive their MLPs will be, so they set the multiplier such that you get paid less for each RVU then if there were no MLPs. This incentivizes getting involved in MLP care since their RVUs go to you. In reality, you’re still making what you were going to make if you play along. If you work a shift that doesn’t have MLP charts to sign, watch your income crater.

Even this depends on your system right. Many of the local jobs have you signing the MLPs charts for $0. This all depends on the system and is internal.

 

[Arcan57]

Even this depends on your system right. Many of the local jobs have you signing the MLPs charts for $0. This all depends on the system and is internal.

Are they RVU pay jobs? If so, how do they get the docs to staff the MLP pts?

 

[BoardingDoc]

Are they RVU pay jobs? If so, how do they get the docs to staff the MLP pts?

Those are hourly jobs from what I've seen/heard. Part of your hourly rate = required signing of MLP charts. One of my friends is working at a place where he doesn't have to sign MLP notes, but if he does during the shift he gets an extra $20/hr or something.

 

[Psai]

Those are hourly jobs from what I've seen/heard. Part of your hourly rate = required signing of MLP charts. One of my friends is working at a place where he doesn't have to sign MLP notes, but if he does during the shift he gets an extra $20/hr or something.

Doesn't sound worth it at all.

 

[EctopicFetus]

Are they RVU pay jobs? If so, how do they get the docs to staff the MLP pts?

No. They write it into their contracts that it is part of your job.

 

[Arcan57]

Those are hourly jobs from what I've seen/heard. Part of your hourly rate = required signing of MLP charts. One of my friends is working at a place where he doesn't have to sign MLP notes, but if he does during the shift he gets an extra $20/hr or

No. They write it into their contracts that it is part of your job.

I see how it would be done with hourly. If it’s RVU based and you get no RVU for MLP charts then the MLPs are never going to be able to staff their patients since it would be costing the docs money.

 

[EctopicFetus]

I see how it would be done with hourly. If it’s RVU based and you get no RVU for MLP charts then the MLPs are never going to be able to staff their patients since it would be costing the docs money.

Yeah. But if you work for me and I say. You are the doctor on the “Q” shift. The Pas sign their charts over to you and you have to review. This is expected of all doctors and it isn’t an optional part of the job.

What are you gonna say?

Hey do I get any credit for their RVUs?

Umm no.. thats my profit *******.

But... ???

Yeah you c an get a job elsewhere or else.. see its simple..

 

[MechEDoc]

Our private group collects about 31-33% of total charges per patient for a total collection of $185-195 per patient on an average month given our patient mix.

Question regarding your collection rate of 31-33% of total charges - is that for total possible charges off of the self pay chargemaster sheet or more typical negotiated rates with a private insurance company? I'm curious as the chargemaster seems to reflect a fantasy set of numbers which is likely a significant inflation over true market value. However, if you're only collecting 31-33% of market value I can't imagine that you can stay in business for very long…

 

[MechEDoc]

No. They write it into their contracts that it is part of your job.

Slightly off-topic, but regarding the compelled cosigning of charts when no true supervision was given to the MLP but cosigning is required by contract/corporate pressure. Is there any evidence that statements such as "I was present in the emergency department during the care of this patient." Carry any legal weight?

 

[MechEDoc]

Regarding the RVU to dollar conversion, I get a sense of what Medicare pays and can usually figure out what Medicaid pays based upon the state reimbursement rate. However, does anyone have any sense of what a typical private insurer pays for an RVU (e.g. How much more valuable is a Kaiser or Blue Cross Blue Shield patient for code 99285 with 4.90 total RVUs?). Also, any wild guesstimates as to how much a self-pay RVU ultimately winds up being worth? I recognize that there would be a mixture of some patients who actually pay the whole bill, some settle their collection prior to the bill being sold to a debt collector, and then a large percentage have their debt sold for pennies on the dollar. However, there must be rough ballparks for the value of a self-pay RVU..?

 

[Hercules]

Question regarding your collection rate of 31-33% of total charges - is that for total possible charges off of the self pay chargemaster sheet or more typical negotiated rates with a private insurance company? I'm curious as the chargemaster seems to reflect a fantasy set of numbers which is likely a significant inflation over true market value. However, if you're only collecting 31-33% of market value I can't imagine that you can stay in business for very long…

Collection rates of total charge are shenanigans at best. You can set your charge as high or low as you want so both an isolated charge and a collection % of charges is close to meaningless. The collections per patient is the key number you need. If they are collecting ~$200/pt they have a very nice payor mix and are doing quite well.

As for your other question about the private insurers, it is very much state dependent. Same goes for self-pay. My numbers may be completely different from a shop 2 states over.


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[Arcan57]

Yeah. But if you work for me and I say. You are the doctor on the “Q” shift. The Pas sign their charts over to you and you have to review. This is expected of all doctors and it isn’t an optional part of the job.

What are you gonna say?

Hey do I get any credit for their RVUs?

Umm no.. thats my profit *******.

But... ???

Yeah you c an get a job elsewhere or else.. see its simple..

If there’s multiple docs on they can refuse to sign saying the other doc should staff pt. Also if the PA needs patient staffed they can find that you’re “too busy right now”

 

[EctopicFetus]

Question regarding your collection rate of 31-33% of total charges - is that for total possible charges off of the self pay chargemaster sheet or more typical negotiated rates with a private insurance company? I'm curious as the chargemaster seems to reflect a fantasy set of numbers which is likely a significant inflation over true market value. However, if you're only collecting 31-33% of market value I can't imagine that you can stay in business for very long…

The chargemaster has nothing to do with self pay. Instead think of it like the sticker price of a car.

Emcare has a level 5 visit charge of around 1500 nationwide.

most democratic groups are closer to 1k (but this is obviously a generalization).

In EM the chargemaster is often 5x what medicare will pay you.

 

[EctopicFetus]

Regarding the RVU to dollar conversion, I get a sense of what Medicare pays and can usually figure out what Medicaid pays based upon the state reimbursement rate. However, does anyone have any sense of what a typical private insurer pays for an RVU (e.g. How much more valuable is a Kaiser or Blue Cross Blue Shield patient for code 99285 with 4.90 total RVUs?). Also, any wild guesstimates as to how much a self-pay RVU ultimately winds up being worth? I recognize that there would be a mixture of some patients who actually pay the whole bill, some settle their collection prior to the bill being sold to a debt collector, and then a large percentage have their debt sold for pennies on the dollar. However, there must be rough ballparks for the value of a self-pay RVU..?

Generally about $30/visit is collected for a self pay. Regarding reimbursement by commercial payers it depends on local norms. It also depends on how big the insurer is in your area. In many parts of the US BCBS is the big player. A friend told me in Hawaii they pay 110% of medicare. Some insurers pay 2-3x this.

 

[EctopicFetus]

If there’s multiple docs on they can refuse to sign saying the other doc should staff pt. Also if the PA needs patient staffed they can find that you’re “too busy right now”

And if this keeps up you will be fired. Ohh.. and you have no due process.

 

[MechEDoc]

If there’s multiple docs on they can refuse to sign saying the other doc should staff pt. Also if the PA needs patient staffed they can find that you’re “too busy right now”

I think the liability of this would also be prohibitive - e.g. "I kept trying to tell the attending physician some crucial detail about this patient and was blown off"… and now there is a bad outcome.

 

[MechEDoc]

Generally about $30/visit is collected for a self pay.

Professional fee or total collection?

The chargemaster has nothing to do with self pay.

Am I understanding the chargemaster wrong?

I was thinking that was the asking price for a given RVU. E.g. Gimme $300 per RVU! Patient - no way! (Ok, how about I sell your debt for $30 and they might collect $50 at some later date). Patient - umm, sure... (due to their profligate approach to finance, etc).

Emcare has a level 5 visit charge of around 1500 nationwide.

Is Emcare actually collecting $1500 per level 5 visit? Or just asking for $1500 per visit?

 

[EctopicFetus]

Professional fee or total collection?



Am I understanding the chargemaster wrong?

I was thinking that was the asking price for a given RVU. E.g. Gimme $300 per RVU! Patient - no way! (Ok, how about I sell your debt for $30 and they might collect $50 at some later date). Patient - umm, sure... (due to their profligate approach to finance, etc).



Is Emcare actually collecting $1500 per level 5 visit? Or just asking for $1500 per visit?

Ok.. here is some background. The Chargemaster is what everyone is charged. Regardless of insurance or anything else. Think of this like sticker price on a car. Its the same for everyone though no 2 people pay the same for that exact same car.

The chargemaster is the charge for each billable thing that happens in the ED. The RVUs dont matter. Emcare will often charge less for critical care than for a level 5 ED visit. The rvus are higher for the critical care right?

So if you have no insuracne and see a doctor and they charge you a $1500 for a level 5 visit.

If you have medicare/medicaid thats all the ED doc (or group) will get paid. They can not balance bill you as they have an agreement with medicare/medicaid.

If you have BCBS, united, cigna etc. and lets say the group has contracted with them (we will use bcbs). Doc group has a deal that BCBS will "allow" $250 for this visit. Thats all the docs can get as they have a contract for that amount.

Now lets say you have United and the ED isnt contracted with them. This is where it gets complicated and you hear about balance billing. Lets just say it is out of network and the ED docs group in states without lws prohibiting balance billing is entitled to the 1500 though they will often negotiate something less.

In the last example, patient with no insurance. So many of these people are the working poor but some are fairly wealthy self employed people/ most of these will pay 0, some will pay some amount between 0 and the total and a small handful will pay the full billed charge. Some groups will help them go onpayment plans etc.

The average collection on self pay patients in the US is about $30.

hope this answers your questions.

 

[MechEDoc]

...hope this answers your questions.

Thanks! It mostly does. The whole business side is very opaque and a little frustrating. Working for a CMG leaves me completely in the dark...

 

[EctopicFetus]

Thanks! It mostly does. The whole business side is very opaque and a little frustrating. Working for a CMG leaves me completely in the dark...

Thats how they like it. They want you to think its incredibly complex and you shouldnt even think of doing it for yourself. Step 1 is get educated.

Internet forums arent ideal to explain this but I am happy to try.

 

[Mbekweni]

Question regarding your collection rate of 31-33% of total charges - is that for total possible charges off of the self pay chargemaster sheet or more typical negotiated rates with a private insurance company? I'm curious as the chargemaster seems to reflect a fantasy set of numbers which is likely a significant inflation over true market value. However, if you're only collecting 31-33% of market value I can't imagine that you can stay in business for very long…

This is off of chargemaster list. Our collections ratio has dropped for the last few years but total charges have gone up for overall similar revenue. It's the neverending battle with insurance providers to try and keep up with inflation or at least try and stave off declining reimbursements. We are collection at or a bit above market value for each patient currently.

 

[EctopicFetus]

This is off of chargemaster list. Our collections ratio has dropped for the last few years but total charges have gone up for overall similar revenue. It's the neverending battle with insurance providers to try and keep up with inflation or at least try and stave off declining reimbursements. We are collection at or a bit above market value for each patient currently.

Curious what number is that?? If you wont put your number out there I would like to see what you define as “market value”?

 

[Mbekweni]

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