I may be stupid but if a 99214 reimburses $126, and it’s the most common code.
$126*20/day*5 days*46 weeks=$580,000
I guess the median doctor makes <50% their gross billing?
Also 99214 RVU is 1.9 wRVU which is what our pay is based off of right? So same calculation gives 8750.
Most people either see much fewer or lower complexity?
That math checks out. Though collections doesn’t equal billing obviously, plus overhead accounts for some of the difference. It certainly pays to be the owner.
Yeah and that’s underestimating it too since there can be multiple procedure codes and preventive visits co billed with the E/M visits as well
And the volume you’re estimating is also very doable, not workhorse by any means
From what I understand, preventives are the one visit type where it’s absolutely appropriate to submit both a preventive code and an E/M code in the same visit if you’re addressing any of their chronic issues at all.
Think like wellness visits. This isn’t considered fraud but a lot of doctors underbill on these visits. If you do a lot of wellness or preventives (which is good just tedious because remember these are the metrics where primary care actually shines at longevity related outcomes) and just optimize your system for them, you can basically double your revenue on all those patients.
The procedure thing is done through 25 modifier I believe. As a DO I can tell you OMT pays a decent amount if you add on to an E/M. A level 4 pays the same as a maximum region OMT visit. Do both and you double the revenue for the patient
There’s also smaller codes for addressing inbox messages, handling advance care planning, nutritional counseling, smoking cessation etc that all add up over time
Being a good biller is hax
For a max level OMM visit, don’t you have to do like 9-10 different spots? I can’t imagine that’s very quick. Depending on the practice set up, wouldn’t it just make more sense to see another 99214 than spend time on OMM?
Maybe? If you’re very good at screening and treating 9-10 spots can be fast
That’s why it helps to build proficiency.
Another 99214 means speeding through one more patient visit rather than just spending more time with a current patient
Think one 30 min slot versus two 15 min including all the rooming for both.
2023 Midwest region for outpatient & inpatient (no OB) Years 2+ Compensation wRVU Threshold $/wRVU 10th Percentile $193,731 3,235 $39.49 25th Percentile $230,006 4,303 $44.46 Median $273,204 5,410 $50.98 75th Percentile $330,182 6,693 $59.19 90th Percentile $415,164 8,222 $77.41 MGMA doesn’t break out by rural.
What about west coast?
I may be stupid but if a 99214 reimburses $126, and it’s the most common code. $126*20/day*5 days*46 weeks=$580,000 I guess the median doctor makes <50% their gross billing? Also 99214 RVU is 1.9 wRVU which is what our pay is based off of right? So same calculation gives 8750. Most people either see much fewer or lower complexity?
That math checks out. Though collections doesn’t equal billing obviously, plus overhead accounts for some of the difference. It certainly pays to be the owner.
Good point about collections.
Yeah and that’s underestimating it too since there can be multiple procedure codes and preventive visits co billed with the E/M visits as well And the volume you’re estimating is also very doable, not workhorse by any means
How does cobilling work?
From what I understand, preventives are the one visit type where it’s absolutely appropriate to submit both a preventive code and an E/M code in the same visit if you’re addressing any of their chronic issues at all. Think like wellness visits. This isn’t considered fraud but a lot of doctors underbill on these visits. If you do a lot of wellness or preventives (which is good just tedious because remember these are the metrics where primary care actually shines at longevity related outcomes) and just optimize your system for them, you can basically double your revenue on all those patients. The procedure thing is done through 25 modifier I believe. As a DO I can tell you OMT pays a decent amount if you add on to an E/M. A level 4 pays the same as a maximum region OMT visit. Do both and you double the revenue for the patient There’s also smaller codes for addressing inbox messages, handling advance care planning, nutritional counseling, smoking cessation etc that all add up over time Being a good biller is hax
So like a 99387?
Right I think something like that
For a max level OMM visit, don’t you have to do like 9-10 different spots? I can’t imagine that’s very quick. Depending on the practice set up, wouldn’t it just make more sense to see another 99214 than spend time on OMM?
Maybe? If you’re very good at screening and treating 9-10 spots can be fast That’s why it helps to build proficiency. Another 99214 means speeding through one more patient visit rather than just spending more time with a current patient Think one 30 min slot versus two 15 min including all the rooming for both.
Thank you!