Rvu

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$80/wRVU, but I'm on the 2020 PFS, so that probably equates to around ~$72 on the 2025 PFS. Semi rural here. City is about 60k population. Nearest big city is 2.5 hours away.
 
Can some of you give a "Day in the life of" description of # of visits/procedures per week with respect to # of RVU's?

For example, what does your week look like if you're producing 10K RVU's?
 
You can just see office visits and hit 10k wrvu if you can bill g2211 and get the 2021 e and m wrvu schedule.

It is only 105 office visits a week for 48 weeks at an average of 2 wrvu per encounter.
 
BobBarker said:
You can just see office visits and hit 10k wrvu if you can bill g2211 and get the 2021 e and m wrvu schedule.

It is only 105 office visits a week for 48 weeks at an average of 2 wrvu per encounter.
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Awesome, thank you.
 
Having a lot of issues getting g2211 approved by billers. The requirements can be fully quite limited. Establishing a longitudinal care plan that can't be copied and pasted is a sticking point.

To be honest... Seems easier to up code a visit - by discussing the social determinants of health that are affecting delivery of care - from level 3 to 4 than figure out and set up the plan for g2211...

FYI 99213 is 1.3 wRVU. Your visits would have to be almost 100% level 4s (which based on time based billing would be 30 minutes per visit for an established patient) as 99214 is I believe 1.92 wRVUs (aapc calculator)
 
Coders/billers read into everything a lot of nonsense that isn’t there. I’m sure you more than deliver on the requirements in the two sentence code description for g2211. They are just choosing not to allow you to bill it.
 
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
 
so55b said:
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
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Complete and utter BS. Transparent excuse to refuse to pay for a covered service, and to cut reimbursement for primary care. They could by the same rationale not bill for any CPT, or could offer only the Medicare conversion factor for $/wRVU. The whole reason hospitals pay higher than that is because they’re able to take it in on facility fees and ancillaries.
 
so55b said:
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
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Might remind them that underbidding is considered as fraudulent as overbilling. Sounds like they would probably fight you hard, but if you were to fight it, they don't have a leg to stand on if it comes down to it. If you're even a mildly productive HOPD doc, they're profiting significantly off you with facility fees to where this should be a little drop in the bucket for them. But it's a bit more significant for us. It's still only responsible for about 6% of my total RVUs, but that is reflective of about $60k of my yearly earnings, all just from G2211. My hospital loses $4 per encounter from it, but they make up the whole year's worth of that by about noon on my first procedure day of the year from facility fees.
 
so55b said:
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
Click to expand...

"They will never love you back."
 
so55b said:
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
Click to expand...

Well medicaid also doesnt justify the $/RVU. Are they also going to have you stop seeing medicaid patients?
 
Status Sciaticus said:
Well medicaid also doesnt justify the $/RVU. Are they also going to have you stop seeing medicaid patients?
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Our hospital actually worked out a deal with medicaid where they get paid more than most insurances. Most hospitals do this from what I've read
 
Last edited:
so55b said:
This is what my admin replied to me about g2211.

" We made an administrative decision last year not to bill the G2211 code across the system. Our rationale was this: reimbursement for this code is only $14.92. The work RVU value is 0.33. Thus for example in your situation we would pay you $25.08 per code and only recoup $14.92 for a loss of $10.16 each time billed. This does not include the staffing cost to code, bill and collect. Therefore, we could not justify and ROI for this code."

So unless your wRVU is less than $40, it doesn’t make financial sense for them to do it for hospital employed docs.
Click to expand...

F*ck them. Tell them to pound sand and submit YOUR claims, on YOUR behalf, as YOUR medical judgment requires them to. They don't get to tell YOU how to bill, YOU get to them them how to bill based upon your skill and experience. If they don't like it, they can attend medical school.

Don't let them push you around.
 
clubdeac said:
Our hospital actually worked out a deal with medicaid where they get paid more than most insurances. Most hospitals due this from what I've read
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Are you a critical access hospital? Most likely reason

Billing is going down hill, the juice remain now only in facility fees.
 
drusso said:
F*ck them. Tell them to pound sand and submit YOUR claims, on YOUR behalf, as YOUR medical judgment requires them to. They don't get to tell YOU how to bill, YOU get to them them how to bill based upon your skill and experience. If they don't like it, they can attend medical school.

Don't let them push you around.
Click to expand...

There could be a case made for fraud and undercompensation that the Department of Labor may be interested in. Especially if they are documenting this nonsense in email format.
 
I have a no opioid practice and see a lot of acute and subacute lbp. I also see lots of patients I do RFA on every yr and repeat epidurals every 3-6 months. Do you think any of those visits warrant a G2211?
 
mdo1738 said:
You’re leaving a lot of money that you earned on the table for no reason
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Maybe.

But I have historically billed mostly level 3s. Now with CMS updates I am doing more level 4s and not using g2211 and have to document each and every time a new long term care plan saves me time and effort and agita.


bedrock said:
If anyone deserves to bill G2211, it is you.
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😊 thanks
 
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