RVU bonus

[time to move on]

Is it PC only or PC + TC if a pathologist is doing all the grossing?

---

Members don't see this ad.

 

[LADoc00]

Usually it is not TC+PC even if you do all the grossing hence why you never want to be grossing anything ever if you are a purely RVU based compensation pathologist.

I would never step into any RVU based employment model unless I could be assured to literally be doing pure slide crunching, no meetings, no ROSE, no post-mortems, no grossing, just crushing mad amounts of glass to get that number sky high. I wouldnt even talk to any clin lab scientists unless the employer had agreed in writing to give me a flat amount of $$ for that as I dont think (someone correct me if Im wrong) the RVU system functions in a clin lab setting (as in you get garbage RVU productivity even if you are doing a millions of tests per year unless those tests have a PC component).

 

[Med Director New England]

Is it PC only or PC + TC if a pathologist is doing all the grossing?

Grossing is part of the professional component of the test, btw.

A paths RVU calculation should never include TC, the only exception is frozen sections that you are performing them with no support, i.e - cutting and staining your self. In that case you can make a argument for a piece of the TC for the frozen bill to go into your RVU total (and you should go after these RVUs if your comp is based on RVU count).

 

[time to move on]

Thank you both. Love the advice on here.

 

[LADoc00]

Grossing is part of the professional component of the test, btw.

A paths RVU calculation should never include TC, the only exception is frozen sections that you are performing them with no support, i.e - cutting and staining your self. In that case you can make a argument for a piece of the TC for the frozen bill to go into your RVU total (and you should go after these RVUs if your comp is based on RVU count).

This is where the actual words of CMS matter.

If the grossing is not performed by a physician, then grossing is not part of the -26 professional component compensation. This is literally of matter of indisputable fact correct?

(quote: Professional component surgical pathology services include the gross and microscopic examination of organ tissue performed by a physician from medicare guidance on this subject)

The argument then follows if grossing can be done by a non-physician with "supervision" by a pathologist then a pathologist grossing is NOT sine qua non to be able to bill for the full professional component, correct?

So if I choose to gross as a physician, I cannot bill any additional fee to payors yes...but I choose not to gross and therefore I win.

See this is where people are getting bamboozled. Grossing by physicians was included in the medicare -26 modifier to prevent devious pathologists from billing an additional amount or even an additional TC code for a case they gross, but no where in the actual medicare guidance does it say or even imply that the amount paid out for the -26 de facto includes all the pre-processing steps like accessioning, grossing etc.

There is no specific duty list with check boxes to say this is part is the TC vs. this is part of the PC aside from the clear separation of reading the slide and rendering a diagnosis vs. cutting the actual paraffin block. Everything else is greyzone folks, dont let pathology groups or hospitals bullsh-t you.

 

[Med Director New England]

This is where the actual words of CMS matter.

If the grossing is not performed by a physician, then grossing is not part of the -26 professional component compensation. This is literally of matter of indisputable fact correct?

(quote: Professional component surgical pathology services include the gross and microscopic examination of organ tissue performed by a physician from medicare guidance on this subject)

The argument then follows if grossing can be done by a non-physician with "supervision" by a pathologist then a pathologist grossing is NOT sine qua non to be able to bill for the full professional component, correct?

So if I choose to gross as a physician, I cannot bill any additional fee to payors yes...but I choose not to gross and therefore I win.

See this is where people are getting bamboozled. Grossing by physicians was included in the medicare -26 modifier to prevent devious pathologists from billing an additional amount or even an additional TC code for a case they gross, but no where in the actual medicare guidance does it say or even imply that the amount paid out for the -26 de facto includes all the pre-processing steps like accessioning, grossing etc.

There is no specific duty list with check boxes to say this is part is the TC vs. this is part of the PC aside from the clear separation of reading the slide and rendering a diagnosis vs. cutting the actual paraffin block. Everything else is greyzone folks, dont let pathology groups or hospitals bullsh-t you.

I would agree that accessioning, courier costs, cost related to operations management are grey zone but in my view grossing is clearly within the PC part of the bill. Delegating grossing is certainly OK and becoming the industry norm so the pathologist can sign out more cases / day. This is important for employed paths when negotiating salary and necessary support. A hospital admin or employer could fairly point out that a part of PC collections for an employed path group be allocated to pay for Path assistant or gross room tech time for their time spent grossing. Both sides benefit from delegating grossing -- paths bill much more and are happier working outside of the grossing room, path employer has more revenue to compensate said path group..

 

[AZpath]

Grossing is part of the PC.

 

[LADoc00]

Grossing is part of the PC.

Im happy to admit Im wrong but in decades of this I have never once seen any documentation breaking down what the professional component MUST include to be billable. Once again, Im happy to admit Im wrong but can you back this up?

Something that specifically states that -26 modifier billers must have performed the grossing of each case. Some itemized list of what say the 40 or so bucks an 88305-26 gets the medicare recipient.

Once again, happy to admit Im wrong if someone can actually produce documentation to this effect. I quoted what I could find, IF the grossing is done by a non-physician, then grossing is part of the TC, IF it is does by a physician then it is part of the PC.

 

[LADoc00]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2714CP.pdf

dig through that bad boy as your reference. Find me something, otherwise literally 'what the PC is what a pathologist does'. There is nothing to actually dictate what a pathologist must do, only what he can do.

 

[Med Director New England]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2714CP.pdf

dig through that bad boy as your reference. Find me something, otherwise literally 'what the PC is what a pathologist does'. There is nothing to actually dictate what a pathologist must do, only what he can do.

LA - I am not saying that grossing has to be done by the path, or even should be but rather that when the global is split into the TC and PC component that grossing in the view of most stakeholders falls into the PC part of the test.
This comes up often in paths who have hospital contracts where the hospital owns or subs out the TC and the path group bills the PC -- determining who pays for the path assistant of it the salary is split how much is covered by the path group

I think the wording that you mention by CMS on the matter above is what allows us to delegate the task....maybe this is why it is worded this way?? By saying that if we dont actually perform the gross than it is not part of the bill keeps us compliant (by not billing a service we didnt provide), but as you mention the bill doesnt change anyways so we arent penalized for delegating grossing (other than the costs to pay whoever grossed the specimen).

Another way to look at this - if a mistake in the final diagnosis occurs because a specimen is grossed poorly or worse specimens are mixed up on the grossing bench with resultant clinical mishap - who do you feel is ultimately responsible for this?
- 1) The path who signed out the case?
- 2) Or the path whose name is on the clia, who signed off on the competence of the grossing tech?
- 3) both

If you say 1 or 3 you are in essence linking grossing (at least liability) to the PC part of the test

 

[LADoc00]

Yankee Medical Director-

I hear what you are saying, trust me I do. Let's look at this yet another way: if the specimen is improperly accessioned, incorrectly typed, erroneous electronically transmitted or contains a floater fragment in the paraffin block, by your logic we are also responsible for courier duties, transcription, IT and even the histology itself.

Then I ask, WTFFFFFFFFFFF does the TC payment (which is MORE $$) buy me then?

I am a stakeholder and an angry one. I will not be shoved down into the mines like a blind donkey and told this is the way it is so suck it up. If a CEO or anyone actually else personally interacting with me telling me I need to gross every case or not get my PC value, they have better be prepared for my response.

Im actually considering selling out now though and doing something else with my life. Perhaps some sleepy basic science lab somewhere with Andy (Yaah remembers this guy), playing around with CRISPR and cell cultures and sipping on craft beer in the afternoon until I cant remember my name. Everything is in medicine now is too dark and gritty for me, life is short.

 

[Med Director New England]

LA - I dont think we disagree on anything esp about the importance of work life balance including finishing work in time for an occasional HH -- I feel delegating grossing is best for path productivity, best for self employed paths, best for employed paths. Some of the other stuff you mention is part of the TC part of the test but still usually falls back on the path group to fix if the owner of the lab pays the group for medical directorship. I am sure we both agree time you spend managing histology quality, dealing with AP IT issues, managing operational issues such as outreach couriers should not be done for free. This time should be factored into the medical directorship fees.

Anyhow, the originator of this post I assume grosses AP specimens and is wondering if (s)he should ask for this to be included in their RVU calculation
Natita you should advocate for yourself and point out that RVU targets and published RVU data is largely composed of paths who dont gross and this is not a fair comparison in your case.

 

[deleted314957]

LA, officially time to hang it up. Believe me, no one should put up with a load of crap unless they MUST. Life is too short.

 

[time to move on]

you should advocate for yourself and point out that RVU targets and published RVU data is largely composed of paths who dont gross and this is not a fair comparison in your case.

100% agree.

 

[musom]

Anyone know how or where to get mean or median $/RVU value from MGMA? I thought I had looked at one some three years ago and there was a median RVU dollar value listed for each specialty?

 

[Med Director New England]

Mean RVUs and mean salary are in the Mgma data for private practice.

You can calculate it this way.
I posted the mgma data a few days ago on a different thread