Amy Boyer MBA

Physicians employed by a medical group, hospital or academic institution are commonly compensated using a productivity formula based on 

 Since wRVUs drive your paycheck, it’s to your advantage to ask questions in order to understand how the system works - and specifically how your employer counts wRVUs.

 to determine reimbursement. The RVU has three components: physician work, practice expense and malpractice. The physician work RVU, or wRVU, is a "neutralized" way to quantify and compare the productivity of physicians because it eliminates variables such as fee schedules or geographical costs.

Most groups multiply the wRVUs for services provided by a conversion factor to determine all or part of a physician’s compensation. For example, a surgeon who is paid at $60.00 per wRVU and produces 6,000 wRVUs would be compensated $360,000.

Read more: The basics of making RVUs work for your medical practice

It seems pretty simple, but as the saying goes, the devil is in the details. Counting wRVUs is not entirely straightforward, and too often a lack of transparency between administrators and physicians, whether intentional or not, sows seeds of doubt that can grow into a tree of distrust and hostility.

To avoid this dismal destiny, ask your administrator these five questions to start the conversation of understanding how the system works. (Administrators, be sure you can answer the questions. Better yet, consider proactively discussing your institution’s wRVU methodology with employed physicians to keep communication lines open and clear.)

1. Are wRVUs credited on codes submitted or codes paid?

In most cases, you will be credited for the CPT codes submitted, regardless of the reimbursement received. But get clarification about that, anyway. Furthermore, understand if reports are generated using date of service or the date the charge was billed out. This will make a difference for those services performed in one month that are billed out the following month. Remember: Delays in billing, whether by you or by the billing team, can delay wRVU credit for your compensation.

Read more: RVUs remain a relevant system to determine physician compensation

2. Do modifiers impact the wRVU credit? If so, how?

Modifier impacts to wRVUs commonly cause physicians to believe they’ve been “cheated” out of compensation earned.

Some groups discount the wRVU for the second side of bilateral procedures, consistent with the reimbursement methodology used by most payers. For example, the CPT code 19318 for a breast reduction surgery has 16.03 wRVUs. When billed as a bilateral procedure (by attaching modifier 50), many payers will reimburse for 150 percent of the fee schedule, not 200 percent. Likewise, the hospital will credit the surgeon with 24.0 wRVUs, not 32.06. Physicians who discover this type of wRVU adjustment months or years into their employment are typically shocked at the perceived deception.

Other modifiers that may decrease wRVUs are:

modifier 59 - distinct procedural service

modifier 82 - assistant surgeon when a qualified resident surgeon is not available
		 

3. What credit do I receive if I bill a code for an unlisted procedure?

CPT codes for unlisted procedures, such as 64999 (unlisted procedure, nervous system), are not assigned a wRVU by CMS. If you use any of the unlisted codes, have a discussion with your administrator about a suitable value for the service. Suggest a similar procedure to use as reference and discuss an appropriate adjustment to the wRVU to reflect the work required for the unlisted procedure.

Read more: Assigning RVU values to procedures that don't have them

4. Who is authorized to change the codes/modifiers I submitted?

Best practice is for physicians to assign the CPT codes for services performed. In most cases, after you submit your codes, a coder or biller reviews the charges and potentially changes the code(s) or modifier(s) based on documentation and payer rules. This directly impacts physician compensation, so you should take interest in who is handling your claims.

Understand the protocol for making changes and insist on a system for being notified. And, ensure that you, as well as the coders and billers, stay current on coding education.

Read more: Using RVUs to measure physician performance

5. Can I see a detailed transaction report each month of the codes submitted and wRVUs credited?

Shrewd physicians insist on reviewing the transaction report each month to ensure all services were billed and to confirm the correct wRVUs were credited for each code. Consider keeping your own log of codes submitted and reconciling it with the monthly report to confirm all services were captured. Doing this monthly is a good habit, allowing you to catch discrepancies early so they can be quickly addressed.

To ensure you are paid for the work you do, it’s essential for physicians to be actively involved with reviewing wRVU calculations. Likewise, it’s important to have open and ongoing communication between physicians and administrators to maintain an accurate compensation plan as well as high physician engagement.

Read more: Cost accounting in the medical practice via RVU

, MBA, is a consultant and speaker with KarenZupko & Associates, Inc. Amy is a dynamic and innovative problem-solver who is highly regarded by physicians for her engaging leadership style, intimate understanding of practice operations and deep appreciation for the patient experience.

Articles

If you're getting paid in work RVUS, then you need to understand what you’re being paid for and how to calculate your compensation.

5 questions to ask about wRVU compensation

There is a significant opportunity in the U.S. for business-minded professionals to have a rewarding career in healthcare as practice managers.

As in any profession, there are average managers who do an adequate job. And then there are the superstars-the managers who care deeply, work fervently, and deliver results time and time again.

So what sets these managers apart from others? What is the “secret sauce” to getting ahead as a practice manager? Let’s talk about five qualities superstar managers possess.

1. Superstar managers excel at the core responsibilities.


Before practice managers can stand out as exceptional, they must first master the core functions of a medical practice. This includes: expertly managing the revenue cycle, financials, human resources, clinic operations, risk management, and compliance. Many of these skills are learned in the field, and some can be enhanced with resources and educational opportunities from organizations like the Medical Group Management Association or specialty societies.

In the quest of mastering the fundamentals, the successful practice manager never says, “That’s not my job.” He or she must be willing to step into virtually any role when needed. Or, in the instance of being asked to handle a situation beyond the manager’s scope or expertise, he or she is resourceful, researching the issue and contacting trusted advisors or experts for guidance. The physicians rely on the manager to handle the problems, big or small.


The healthcare environment is evolving, and managers who fail to adapt will be left behind. Accept the reality, embrace the challenge, and boldly lead the way. Just as physicians must stay current on clinical advances, successful managers must keep abreast of changes such as new technologies, shifting payer reimbursement, changes in market demands, and the swinging pendulum of physician employment. They will proactively anticipate challenges that may arise from the change and quickly develop solutions.

3. Superstar managers retain a teachable spirit.


The body of knowledge in healthcare management is vast, and as just stated, ever-changing. The most successful managers understand that they will never know it all and remain open and willing to learning new ideas.

Jason Cornelius, MHA, MBA, chief operating officer at Fort Worth Brain and Spine in Fort Worth, Texas, advises: “Always stay humble and never stop learning. Surround yourself with people who are smarter than you, who can mentor you, and people who have ‘more gray hair’ than you.” Adopt the mindset of being a lifelong learner. And keep in mind that new teachings can come from various sources, including employees who report to you.

4. Superstar managers think like both a clinician and a businessperson.


Successful medical practice managers not only understand the fundamentals of the business, but also have foundational knowledge of the medical specialty and the clinicians who are providing the service. They seek to understand what drives and impassions the providers. They shadow clinicians, ask questions, and take a clinical interest in what they do. After all, the business of medicine is entirely dependent upon patients and the providers of care.

5. Superstar managers nurture relationships.


Truly successful managers develop the keen ability to perceive and assess others’ emotions and develop enhanced communication techniques, flexing their style to most effectively communicate their message. They nurture relationships with physicians, staff, vendors, hospitals, payer representatives, etc., even the most challenging ones.

“Never burn bridges,” says Cornelius, “because strong and healthy relationships are vital to success.” Learning to communicate, listen, and understand others will carry you extraordinarily far in your career.

She has 15 years of experience working with physicians in private practice, hospital-based practice, and academic settings. Boyer specializes in practice operations, revenue cycle, and the use of technology to improve productivity. She frequently advises residents and young surgeons about employment agreements, compensation, and practice start-up issues.

Careers in medical practice management can be tough, but there are exceptional leaders who can master it all. Learn the key qualities you need for success.