Pro Fee for BVNA and MILD

[drusso]

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Just wondering what people are seeing and if they think the juice is worth the squeeze.

 

[clubdeac]

Just wondering what people are seeing and if they think the juice is worth the squeeze.

I think our group is getting like 7-8 wRVU which comes out to about $500

 

[BobBarker]

Mild pays well for the time. Usually, around $800. But you can do a max of two cases an hour. It is probably closer to 3 cases in 2 hours.

BVNA is terrible. About $425.

 

[Taus]

Bvna on pro fee only is a charity case, lose money per time spent versus just about anything else we do.

Even when there are approvals on commercial payers via appeals… Where they still technically consider it experimental… Your practices contracted rate with that carrier doesn’t apply if it is not on their official approved list of codes. Has defaulted to mc rates. It was worthwhile when cigna had it on policy, paying contracted rates, before evicore took over their pain auths. Hopefully they will get that back and some other national commercial carriers come on board soon. As it stands, my local major blue has declined to pay retroactively after cases approved on appeals and completed. I still offer the procedure for patients whose insurance covers it on policy (traditional mc and Highmark) bc it truly works as advertised, but cap at two per month, as I can only do so much charity care.

Totally different if you are getting a piece of the facility fee. I do about 90% of my procedures in the office on global fee, only one day per month in the OR. I refer out more than I do…. Hospital docs on rvu who don’t care if case gets paid and how much.

 

[bedrock]

Bvna on pro fee only is a charity case, lose money per time spent versus just about anything else we do.

Even when there are approvals on commercial payers via appeals… Where they still technically consider it experimental… Your practices contracted rate with that carrier doesn’t apply if it is not on their official approved list of codes. Has defaulted to mc rates. It was worthwhile when cigna had it on policy, paying contracted rates, before evicore took over their pain auths. Hopefully they will get that back and some other national commercial carriers come on board soon. As it stands, my local major blue has declined to pay retroactively after cases approved on appeals and completed. I still offer the procedure for patients whose insurance covers it on policy (traditional mc and Highmark) bc it truly works as advertised, but cap at two per month, as I can only do so much charity care.

Totally different if you are getting a piece of the facility fee. I do about 90% of my procedures in the office on global fee, only one day per month in the OR. I refer out more than I do…. Hospital docs on rvu who don’t care if case gets paid and how much.

Mild pays well for the time. Usually, around $800. But you can do a max of two cases an hour. It is probably closer to 3 cases in 2 hours.

BVNA is terrible. About $425.

I've never been to a course, but isn't there a fair amount of extra radiation exposure with MILD? That makes me less interested.

It is unfortunate that these two procedures which really help patients avoid much more expensive and dangerous surgeries, pay so poorly.

Agree with Taus on intracept. My practice is over 10% cigna. It wasn't lucrative, but at least financially worthwhile to do Cigna intracept cases (while Cigna still paid for them). Now with Cigna mostly out of the picture, given the time it requires, intracept with any other payor is essentially charity care, which pays less than clinic. Medicare pays next to nothing and BCBS isn't much better.
This fall, I stopped offering intracept. I have a few cases pending auth that I will complete, but I'm not offering it to any more patients. If I do identify a good intracept candidate, I will still refer them to a HOPD employed doc who likes doing them, but I'm done offering intracept after this year. But not all areas have a physician ready to regularly provide intracept. In some places no one will offer intracept due to the poor pay, which results in unnecessary fusions (which are much more expensive than intracept). Maybe medicare and other insurances will eventually wake up to this financial boondoggle they’ve created.

Regarding piece of the ASC fee. I'm one of 8 partners with an equal share of ASC profits. In the past 12 months I've brought in $400,000 in facility fees from intracept alone. However, our ASC is not efficient (due to ortho) and so I figure I've only personally gained about $10,000 from the facility fees. And that 400K includes a number of cigna cases in the first 6 months, which paid much more than medicare or BCBS. Now that Cigna is almost impossible to auth, both pro and ASC payment is much worse, and I can make significantly more money doing bread and butter cases in the ASC.

 

[Ronin1]

I don’t mind doing bvn as an HOPD doc as we do it with sedation in our suite. It’s a 30 min slot for 7 wrvu pellets. Not terrible and it works. We negotiated 13 wrvu units for mild als in our suite but that’s usually an hour slot

 

[bedrock]

I don’t mind doing bvn as an HOPD doc as we do it with sedation in our suite. It’s a 30 min slot for 7 wrvu pellets. Not terrible and it works. We negotiated 13 wrvu units for mild als in our suite but that’s usually an hour slot

Glad you offer intracept. It can’t consistently be done in 30 min, particularly if you are treating 2 disc levels (3 nerves).

 

[Ronin1]

Glad you offer intracept. It can’t consistently be done in 30 min, particularly if you are treating 2 disc levels (3 nerves).

Agreed but I mostly do two nerves and I don’t go looking for referrals. Mainly my own patients so it’s at most one a week. Maybe the Stryker equipment will be faster with multi lesion capability