Psych NP inpatient per patient fees?

[resilientnurse]

Greetings,

Does anyone know how inpatient psychiatric compensation works? A psychiatrist has offered me an opportunity to join his inpatient medical group at a local hospital. He asked me directly how much I wanted and how I wanted to be paid. When I said $80/per hour (thinking I was demanding something exceptional), he looked at me like I was an alien from another world. "I think that you can make more money if I pay you per patient. Eighty dollars an hour is too low." But he would not say how much he is willing to pay.

So, he wants me to get back to him regarding how much I want per med review and psych eval. I am assuming that he has a contract with the hospital, because he will be paying me directly as opposed to the hospital. Does anyone have any idea as to how this works and what I should be asking for? I do not want to continue to low-ball myself.

Any information you can provide would be greatly appreciated. Thanks.

[mzaur]

I have no clue, but isn't it different for every state and insurance company? There must be some way for you to find out how much they bill for

[core0]

I'll preface this by saying that I know a lot about billing and coding and very little about how psych billing operates. Looking at the American Psychiatric Association billing section it appears that most inpatient psychiatrists bill in a manner to other inpatient physicians. There is a separate code for Psychiatric Diagnostic Eval with med services but since it pays less that a level 3 initial hospital care visit I would assume you use that instead.

For med visits its going to depend on what you are adjusting, but assuming that you are mostly adjusting prescription meds then you can do a level 2 follow up visit pretty easy. This reimburses 1.39 RVUs. If you can do a level 3 visit it reimburses 2.0 RVUs.

I assume you know whats reasonable to see per hour. For example if you can see a patient every 10 minutes then you bring in 8.34 RVUs per hour. Now this includes reviewing records, finding and examining the patient, writing orders and writing the note. If every 15 minutes is reasonable then you you are looking at 5.56 per hour, three per hour 4.17 and two per hour would be 2.78.

Now the part you don't know. What is there blended RVU. This is the amount that is paid per RVU averaged over all payors. The Medicare rate is around $32 an RVU. Medicaid will pay less. Private insurers will pay more. Self pay will pay nothing. Where I work for example with a Medicare heavy population its $39 per hour. So if I see four patients an hour with level 2 inpatient follow up I bring in $185 per hour ($218 x .85 for NPP medicare reimbursement). In reality its a little higher since most commercial insurers reimburse at 100%.

So at pure medicare rates you would bring in around $40 per patient. Now that doesn't cover your benefits malpractice etc. Also if you are working piece work its feast or famine. If you don't have many patients then you don't make any money. In addition with piece work there is an emphasis on through put which if you get reviewed may earn you a more careful audit.

A better system would be a salary with a bonus of some type based on production. Remember that $80/hour is $160k per year for full time work. Now this also depends on what type of employee your are (1099 vs regular) are they paying malpractice etc. Without knowing more about the offer (benefits etc) and what they get paid its hard to give an educated answer to your question.