RVU-Based Bonuses

RVU-based bonus? Depending on the payor mix, either the practice or the employee may be shortchanged. In practices with a lot of self-pay (often becomes no-pay), the practice may be shortchanged because a certain level of RVU’s (i.e.-production) will result in lower practice income. In practices with a payor mix of traditional high-reimbursing carriers, the employee will be shortchanged because the same level of RVU’s (i.e.-production) will result in higher practice income.

I prefer income-based bonuses. The more or less income the practice earns based on the employee’s services, the more or less bonus the employee gets.
Also, to base a future bonus on current base-year RVU’s gives an incentive to the employee to work less in the current year, thereby raising the RVU-percentage increase for the next year. By the same token, it gives the employer an incentive to overload the new employee with work in the current year, making future year RVU-percentage increases relatively lower.
In summary. I like income-based bonuses WITHOUT REGARD to prior year income. What does one year have to do with the next? The RVU-based bonus looks like a way to “incentivize”the employee, but it is not based on actual income, only some theoretical calculation of work. It can be restated this way: Pay me based on what income I generate, not the number of hours (which will increase RVU’s) I work.
In addition, in this PM&R job market, the employee is in a good position to negotiate more favorable compensation terms.
This article Was contributed by Bruno Stillo, Physiatry Billing Specialists. 800-836-4482,  physiatrybillman@aol.com

Your Strengths and Weaknesses

One typical interview question is about your strengths and weaknesses. As always with interview questions, it’s best to prepare your answers beforehand. Don’t be afraid to brag when talking about your strengths or when asked to tell them about yourself. Also, if you can preface the response to say that someone else spoke to your strengths, such as your attending or CEO, and said that you’re very conscientious, reliable, make yourself readily available, etc., that is of added value. Try to incorporate your examples of strengths not only when asked directly but also weave the examples into answers to other questions that might be asked such as, “How do you feel about going out and talking with referral sources?”  I actually enjoy talking with other doctors and promoting the abilities of PM&R. I recently spoke to a community group about arthritis.”

The weakness response is one which usually requires some thought. Good responses are ones that take a negative and turn it into a positive. For example “My weakness is that I get so wrapped up in work that sometimes I don’t take enough time for myself.”  Do not discuss weaknesses that are strong negatives such as poor time management, inability to get along
with others, tardiness, etc.

The most important aspect of good interview behavior is to display confidence. In turn, it’s best to respond to the weakness question at first to say “l can’t think of a weakness offhand but to respond to your question, it’s always best to read and keep current with medical literature so I could always spend more time reading.”

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Questions that Count

These days more and more entities looking to add a doctor are asking questions about productivity. These questions may be part of the initial conversation so be prepared. As I mentioned in my most recent blog, be prepared to answer questions such as:

1.  What is your current acuity level?

2. What is your average length of stay?

3. How many patients/day are you accustomed to seeing and how many would you like to see? How many would you consider to a full load?

You should also be asking the interview quantitative questions such as the following:
1. What is the average daily census?

2. What is the call schedule?

3. What is the time allotted for new and follow-up patients?

As a recruiter. I ask these questions and have additional questions so you should be prepared to provide the answers. I am also willing and able to ask any questions you might have of the hiring entity without mentioning your name. If the hiring entity hesitates to answer these questions or provides little information then that is a potential red flag.

When To Look for a New Doctor

Finding a good match for your practice opportunity continues to be a challenging endeavor. If you want to add a new graduate, this process becomes even more challenging as most residents go onto do a fellowship. It’s best to look for a new doctor as soon as you know you have a need. I suggest that you start your search at least a year before you need the doctor.

The Offer

The Offer
One of the goals of a practice search is to obtain an offer. An offer can be in verbal form, a letter of intent or an agreement. A verbal offer should always be followed-up by a written offer. The letter of intent is often a brief summary of the terms of employment to include the benefits. If this is acceptable to both parties, then an agreement typically follows.

You should expect to receive an offer either at the end of your interview(s) or shortly after your interview(s). However, if the hiring entity is interviewing several doctors, it could be months before an offer is extended. It is not forward to ask the hiring entity where it is in the search process so you can have an idea as to when a decision will be made.
Don’t be surprised if it takes awhile to receive the agreement. The hiring entity often seeks legal input to prepare the agreement and this adds time to the practice search process. Again, ask when you might receive it and use this time frame as a benchmark. If the time to get the agreement goes past the unreasonably past the benchmark time, then you should further engage discussions with the other practice opportunities you’re considering.
Once you have an offer, ask for some time to consider it. Be open with them about any other interviews you might have planned before you make a decision so they also have a time frame. If you decide against accepting the offer, do it graciously as possible as rehab is a small world and, who knows, you might find yourself working with the practice in the future!

Interview Question and Dialogue

The typical interview starts with the question, “Tell me about yourself.”  This is the perfect entree for you to highlight your accomplishments and abilities. Rather than starting with I was born in XYZ town and decided early on that I wanted to be a doctor, start by highlighting your most significant accomplishment. If possible, your accomplishment should be quantifiable as well as 0ne of quality. For example,  “I have published 10 research papers or . . .  developed a rehab unit whose census climbed to 20 in the first year.

If you are on experienced doctor, try not to overload the interviewer with your knowledge of the field. Sometimes when you say too much, it uncovers information which may not be accurate and therefore to your disadvantage. Even though you are an expert, the interviewer ultimately wants to feel that you will be a team player and not always wanting the limelight.

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Lioresal Pump Management – Coding Changes

Some physiatrists have developed a boutique practice in analyzing, reprogramming, and refilling
implanted Lioresal (generic name is Baclofen) Pumps. CPT coding changes effective
January 1, 2012 no longer split the “Refill” and the “Reprogramming” when done together.
A list of CPT Coding for Lioresal Pump Management follows:

Approx
Medicare-2015
CPT Code CPT Summary Description Allowed
95990 Refill & maintenance ONLY with or without 90
Analysis, no reprogramming (by Non-physician)

95991 Refill & maintenance ONLY with or without 120
Analysis, no reprogramming (by Physician)
————————————————————————————————————-
62367 Analysis, no Reprogramming, 40
no Refill

62368 Analysis + Reprogramming, no Refill 60
————————————————————————————————————-
62369 Analysis + Reprogramming + Refill 120
(performed by Non-physician)

62370 Analysis + Reprogramming + Refill 130
(performed by Physician)

Examples for Coders/Billers
If a physician performs the Refill alone, no Analysis, no Reprogramming, then code 95991.
If a physician performs the Refill + Analysis, no Reprogramming, then STILL code 95991.
If a physician performs the Analysis, no Reprogramming, no Refill, then code 62367.
If a physician performs the Analysis + Reprogramming, no Refill, then code 62368.
If a physician performs the Refill + Analysis + Reprogramming, then code 62370.

Lioresal Medication – J0475
Lioresal medication is EXTREMELY expensive, and can cost from $200 to $1600 per visit. It is
important to bill the correct quantities of the J0475 code to obtain the correct insurance
reimbursement. Since the billings to Medicare must be reported as units, the correct drug code
must be converted to the correct number of units. The 2015 Medicare allowed amount for CPT
J0475 is approximately $210 per unit, which may assist you in converting the medication to units.
An incorrect conversion to units can easily cost the practice thousands of dollars. As it relates to
practice income, the profit on the medication is small, barring any appreciable discount from
Medtronic.

Summary
A physiatry practice can make good income from the procedures related to analyzing,
reprogramming, and refilling implanted Lioresal pumps, along with a small income from
billing the medication itself.

Contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482, www.physiatrymedicalbilling.com, physiatrybillman@aol.com

The Interview

Preparation is the key to a successful interview.  Go through a mock interview, pretending to be in the interview and answering the questions that might be posed.  Use past interviews to inform you of what questions might be asked.  Situational questions may be asked such as “How do you handle a difficult patient? ”  These are often questions with no easy answers and no right or wrong answers.  Think what answer best portrays your ethics and personality.

Be prepared with your own questions.  The interview should be more like a conversation than one-sided by the employer. Questions about the doctor’s medical philosophy and treatment patterns are extremely important to see if you fit their practice and if their practice fits you.

Asking about compensation is tricky.   When should it be raised? Follow the lead of the employer but don’t go past the phone conversation after the first interview without asking this question. Working with a recruiter often helps because the recruiter can often obtain this information for you.

The Practice Search Timeline

I’m often asked by practices and hospitals who are looking for doctors about how long it will take to find physiatrists. The answer depends on alot of factors to include. how rural the location is. how competitive the compensation is, how attractive the services are, e.g. outpatient and interventional are more attractive these days to most physiatrists. etc. Once candidates have been identified. then it’s a matter of how responsive the practice is with follow-up, whether the new doctor is licensed in the state or not, how long it takes to provide the new doctor with a contract. etc. Usually the process takes about 6 months.

From a doctor who is looking for a new position. the timeline is also usually longer than anticipated. This is for all of the reasons above and the multitude of other possibilities that could be the case. Usually it takes a practice/hospital about 2 weeks before they review your curriculum vitae. Then, the practice might ask Farr Healthcare. Inc. to do a preliminary interview. The next step if all goes well is the scheduling of a phone interview between the candidate and the practice/hospital. Often. this involves many individuals at the practice/hospital so it may take several weeks or more to identify a mutually satisfactory phone interview date. The same is true for when an on-site interview is scheduled. Before the on-site interview, references will be requested and checked. Again, the timing of their completion is dependent on the availability of the parties involved. Once an on-site visit is completed satisfactorily, then a contract will be presented. Some practices/hospitals have contracts prepared and other practices/hospitals have to go to their lawyer which may take awhile. Contract negotiation also may take weeks into months.

The Work of a Physician Recruiter

The physician recruiter is hired by the entity looking for a physiatrist. The compensation is a flat fee which is paid when the position is filled. The fee for physician recruitment is tax deductible. The physician recruiter has an obligation to find a physician for the entity. The recruiter should have the best interests of both the hiring entity and the new doctor in mind. If a new doctor starts and leaves shortly thereafter, it doesn’t serve anyone well. Depending on the area of the country and the nature of the position, anywhere from a few to many candidates will be presented to the hiring entity.