RVU production compensation questions

[anonperson]

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For any of the surgeons who have a contract that is wRVU based. I wanted to get some insight due to my own upcoming contraction negotiation (OBGYN).

1. If you are assisting a partner/another surgeon in a case, how are you as the assist getting compensated for this regarding the number of wRVU? Is modifier 80 applied. So if the surgery is an exploratory laparotomy (CPT 49000, wRVU 12.54) are you getting credit for 0.16 x 12.54=~2 wRVU?

2. Are your wRVUs being calculated on what your are submitting to billing/coders or what is actually being paid out on? If on what is being paid out on, how are you getting credit for uninsured patients if they are essentially never going to pay? If it is based on what is submitted, who is double checking the coding for any errors or discrepancy that may occur?

3. Is it more common for the wRVUs to be credited on the date of service or the date the charge was billed out? I presume being credited on the date of service is more beneficial for the physician but wanted to make sure.

4. If multiple procedures are performed, is the multiple procedure modifier used to decrease the number of wRVUs you are credited for?

 

[VA Hopeful Dr]

Not a surgeon so I can't help with most of those, but for #2 the whole reason to use RVUs is they are payor neutral. An RVU is the same whether it's billed to medicaid, medicare, or blue cross.

If you work for a large system, they will usually have coding people that watch you very closely at first to make sure you know what you're doing coding wise.

 

[Wordead]

For any of the surgeons who have a contract that is wRVU based. I wanted to get some insight due to my own upcoming contraction negotiation (OBGYN).

1. If you are assisting a partner/another surgeon in a case, how are you as the assist getting compensated for this regarding the number of wRVU? Is modifier 80 applied. So if the surgery is an exploratory laparotomy (CPT 49000, wRVU 12.54) are you getting credit for 0.16 x 12.54=~2 wRVU?

2. Are your wRVUs being calculated on what your are submitting to billing/coders or what is actually being paid out on? If on what is being paid out on, how are you getting credit for uninsured patients if they are essentially never going to pay? If it is based on what is submitted, who is double checking the coding for any errors or discrepancy that may occur?

3. Is it more common for the wRVUs to be credited on the date of service or the date the charge was billed out? I presume being credited on the date of service is more beneficial for the physician but wanted to make sure.

4. If multiple procedures are performed, is the multiple procedure modifier used to decrease the number of wRVUs you are credited for?

Im fresh out so with a grain of salt:

1. Why would you ever do this? An attending spending 3 hrs in the OR for 2 RVUs? That's bananas. Is this common? For joint cases usually we do a 62 modifier and I think you each get 60% of the RVUs

2. As said above it's payer neutral and the coders are double checking you and giving you feedback.

3. Mine seem to be credited on day it's billed out since I get some credits the month ago.

4. Not sure as I havent followed this closely in my reports. Hopefully someone else has an answer.

 

[anonperson]

Im fresh out so with a grain of salt:

1. Why would you ever do this? An attending spending 3 hrs in the OR for 2 RVUs? That's bananas. Is this common? For joint cases usually we do a 62 modifier and I think you each get 60% of the RVUs

2. As said above it's payer neutral and the coders are double checking you and giving you feedback.

3. Mine seem to be credited on day it's billed out since I get some credits the month ago.

4. Not sure as I havent followed this closely in my reports. Hopefully someone else has an answer.

Thanks

Regarding modifier 62, I was under the impression it was for 2 different surgeons working at the same time.

If one truly just needs an assist, is the assist stuck with getting credit for just those couple of RVUs?

 

[Wordead]

Thanks

Regarding modifier 62, I was under the impression it was for 2 different surgeons working at the same time.

If one truly just needs an assist, is the assist stuck with getting credit for just those couple of RVUs?

I've coded it a few times - once with my partner, and a couple times with the spine guys for anterior approaches to the spine. That's what we used.

If you just need an assist Id just get a RNFA or something. If I got 2 RVUs to help in a long ass case I'd never help anyone to be honest.

 

[DoctwoB]

For any of the surgeons who have a contract that is wRVU based. I wanted to get some insight due to my own upcoming contraction negotiation (OBGYN).

1. If you are assisting a partner/another surgeon in a case, how are you as the assist getting compensated for this regarding the number of wRVU? Is modifier 80 applied. So if the surgery is an exploratory laparotomy (CPT 49000, wRVU 12.54) are you getting credit for 0.16 x 12.54=~2 wRVU?

2. Are your wRVUs being calculated on what your are submitting to billing/coders or what is actually being paid out on? If on what is being paid out on, how are you getting credit for uninsured patients if they are essentially never going to pay? If it is based on what is submitted, who is double checking the coding for any errors or discrepancy that may occur?

3. Is it more common for the wRVUs to be credited on the date of service or the date the charge was billed out? I presume being credited on the date of service is more beneficial for the physician but wanted to make sure.

4. If multiple procedures are performed, is the multiple procedure modifier used to decrease the number of wRVUs you are credited for?

Also not in practice too long and not a billing savant, so take this with a grain of salt.

1. It depends on the case. If you are truly just assisting your partner that is correct you bill modifier 80 and get 16%. If you and your partner are doing a case together with different portions (e.g. I'm a urologist, my partner performs ureteroscopy to facilitate my percutaneous renal access) we each bill separately for the part of the procedure we performed and can bill an 80 modifier if we assisted on the other portions. 62 modifier refers to surgeons of a different specialty performing different parts of a case under the same CPT code.

For example last week I did a nephrectomy/sarcoma resection with a surgical oncologist. I billed (and dictated) the nephrectomy with its own code without a 62 modifier because that has its own CPT code. The surgical oncologist billed the sarcoma resection. I billed as an assistant for the sarcoma resection with 80 modifier and she did the same for the nephrectomy.

It all comes down to what codes are involved. Single CPT code cases tend to be money losers when it comes to assisting. But it is good for patients and fun to operate with your partners, so its worth taking the hit sometimes.

2. What you bill. As mentioned above that is the whole perk of RVU billing which is youre not on the hook for collections or insurance payment rates

3. Our are credited at time of service though subject to audit, can't speak for other sites

4. Yes

Finally while RVU billing has its pros and cons, the biggest factor you should look at is your conversion factor, meaning how many $ per RVU. That is quite literally how hard you have to work for the money you make. Look up median RVU values for your specialty, and see what your salary would be if you were at median productivity or 20% below or above.

 

[ThoracicGuy]

For any of the surgeons who have a contract that is wRVU based. I wanted to get some insight due to my own upcoming contraction negotiation (OBGYN).

1. If you are assisting a partner/another surgeon in a case, how are you as the assist getting compensated for this regarding the number of wRVU? Is modifier 80 applied. So if the surgery is an exploratory laparotomy (CPT 49000, wRVU 12.54) are you getting credit for 0.16 x 12.54=~2 wRVU?

2. Are your wRVUs being calculated on what your are submitting to billing/coders or what is actually being paid out on? If on what is being paid out on, how are you getting credit for uninsured patients if they are essentially never going to pay? If it is based on what is submitted, who is double checking the coding for any errors or discrepancy that may occur?

3. Is it more common for the wRVUs to be credited on the date of service or the date the charge was billed out? I presume being credited on the date of service is more beneficial for the physician but wanted to make sure.

4. If multiple procedures are performed, is the multiple procedure modifier used to decrease the number of wRVUs you are credited for?

1. In our practice, we get 50% of the billed RVU when we are helping out on each other's cases.
2. Our numbers are based on billed RVU
3. I believe ours are based on DOS.
4. Not sure, but I suspect it is.

 

[cpants]

1. There are only specific times when you can use 62 modifier, usually when 2 specialties are working together -- eg. General surgeon helping ortho spine to get anterior access. If you are simply assisting your partner on a hysterectomy, you only get reimbursed for 16%. No rule that your employer has to pay you out at 16% RVU though. 50% sounds like a pretty good deal.

2/3. Will vary based on institution. It should be in your contract, or else ask them about it.

4. Yes you get paid at 50% for additional procedure in most cases.