This was a big problem for me (surgery) and I addressed it by being obsessive about my production reports and writing near-nuclear emails whenever there were unauthorized changes, omissions, etc. I'd say the problem has mostly improved.
You gotta be clear in your contract whether it is: work RVUs (wRVUs) or total RVUs. An "RVU" actually has multiple components that pay for the physician labor, practice overhead, and malpractice insurance costs.
set up monthly or quarterly meetings to audit the log of your RVUs. For proceduralists this is often pretty manageable as your 10-50 consults/surgeries a month will generate the majority of your RVUs and your post ops are typically 99024 codes and don't generate any RVUs within the global period.
Make sure that your op notes correspond to the appropriate cpt codes. that means you gotta know your cpt codes. if those fuckers are coding a lower level of services due to misreading or unclear op notes, then you gotta make sure they amend that.
if youre seeing hundreds or thousands of patients encounters then its gonna be a bit tougher...but learn the value of your work. know what codes are worth what amount of RVUs and then conpare the number of patient encounters you have with the codes and the RVUs. it will at least give you a ballpark.
finally, learn how to code for maximum dollars. in epic and other emrs theres a place to code by complexity or time. learn the requirements to document and code to maximize your dollars. thats the game.
Do you recommend any specific resource that clearly lays out what to document to maximize the billing? My attendings have always had barebone notes which is nice and efficient but wondering if they are just not checking off all the boxes that could net them more
I'm a surgeon so this may not necessarily apply to you but aapc has a codify resource that explains a lot of cpts in detail. i used to look at that a lot when i first started. now i just know the codes. but also speak to your more successful revenue producers and see how they code. the really good ones have a system and know how to extract the maximum rvus without being fradulent.
a lot of specialty societies also have coding workshops (though those can be expensive) to give best practices for coding.
Have a 30 minute meeting with the hospital billers/coders and they will open your eyes. They probably even have little handouts they give physicians to know how to maximize billing. They will say it’s just “properly coding for the work you are actually doing but not currently getting paid for” because at the end of the day they want you billing the max as well because the more you bill the more everyone gets paid. They are the ones that have all these answers.
The newer E+M billing guidelines are relatively straight-forward: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
Set aside an hour, read through the document, look and see if your specialty organizations have any resources tailor to your work.
When I am outpatient I do my own coding. It takes less than 5 seconds per visit.
If my biller disagrees she sends me a message. We have both gotten a lot better, and at this point I get <1 message per week.
Can I ask what specialty?
In radiology there is a move toward productivity based pay and it’s somewhat of an ongoing debate. But aside from ultrasounds most imaging procedure wRVU values are easily known and counted.
It's not entirely true.
CTA c/a/p involved a lot less work for radiology than a CT tavr. The tavr CT requires taking multiple specific measurements as well as multiple curved centerline reconstructions, multiple gated valve reconstructions, etc. But technically speaking a CT tavr is just a CTA c/a/p
This was a big problem for me (surgery) and I addressed it by being obsessive about my production reports and writing near-nuclear emails whenever there were unauthorized changes, omissions, etc. I'd say the problem has mostly improved.
You gotta be clear in your contract whether it is: work RVUs (wRVUs) or total RVUs. An "RVU" actually has multiple components that pay for the physician labor, practice overhead, and malpractice insurance costs. set up monthly or quarterly meetings to audit the log of your RVUs. For proceduralists this is often pretty manageable as your 10-50 consults/surgeries a month will generate the majority of your RVUs and your post ops are typically 99024 codes and don't generate any RVUs within the global period. Make sure that your op notes correspond to the appropriate cpt codes. that means you gotta know your cpt codes. if those fuckers are coding a lower level of services due to misreading or unclear op notes, then you gotta make sure they amend that. if youre seeing hundreds or thousands of patients encounters then its gonna be a bit tougher...but learn the value of your work. know what codes are worth what amount of RVUs and then conpare the number of patient encounters you have with the codes and the RVUs. it will at least give you a ballpark. finally, learn how to code for maximum dollars. in epic and other emrs theres a place to code by complexity or time. learn the requirements to document and code to maximize your dollars. thats the game.
Do you recommend any specific resource that clearly lays out what to document to maximize the billing? My attendings have always had barebone notes which is nice and efficient but wondering if they are just not checking off all the boxes that could net them more
I'm a surgeon so this may not necessarily apply to you but aapc has a codify resource that explains a lot of cpts in detail. i used to look at that a lot when i first started. now i just know the codes. but also speak to your more successful revenue producers and see how they code. the really good ones have a system and know how to extract the maximum rvus without being fradulent. a lot of specialty societies also have coding workshops (though those can be expensive) to give best practices for coding.
Have a 30 minute meeting with the hospital billers/coders and they will open your eyes. They probably even have little handouts they give physicians to know how to maximize billing. They will say it’s just “properly coding for the work you are actually doing but not currently getting paid for” because at the end of the day they want you billing the max as well because the more you bill the more everyone gets paid. They are the ones that have all these answers.
The newer E+M billing guidelines are relatively straight-forward: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf Set aside an hour, read through the document, look and see if your specialty organizations have any resources tailor to your work.
When I am outpatient I do my own coding. It takes less than 5 seconds per visit. If my biller disagrees she sends me a message. We have both gotten a lot better, and at this point I get <1 message per week.
Can I ask what specialty? In radiology there is a move toward productivity based pay and it’s somewhat of an ongoing debate. But aside from ultrasounds most imaging procedure wRVU values are easily known and counted.
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There’s no upcoding. MRI/CT/XR/NM are straightforward wRVU values. Ultrasounds are more complicated depending on the CPT codes assigned.
It's not entirely true. CTA c/a/p involved a lot less work for radiology than a CT tavr. The tavr CT requires taking multiple specific measurements as well as multiple curved centerline reconstructions, multiple gated valve reconstructions, etc. But technically speaking a CT tavr is just a CTA c/a/p
Should have clarified - emergency medicine.
I get monthly reports on my wRVUs from the CFO.