Billable Hours

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Can someone please explain billable hours?! I interviewed for a case management job and left the interview confused on what my pay would be. I was told I would make $35/hr and be paid biweekly per the billable hours I turned in. They said .1 = 6 minutes etc; full time case load is 15 cases billing 20-23 hours per week. How does that compare to a normal 40 hour paycheck at $35/hr? They said the opportunity to make good money is there if nurses increase their case loads above 15. I am single and need to make sure I am making enough to survive.

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.

Billable hours, imo, is a bad way to make a living unless you are good at sales and/or commission type of work! You will not get paid for any time that is not considered "billable" and they will only pay you a portion of what they are able to bill for your documented services. I worked in a facility that billed for services and gave bonuses etc. based upon "production" work. It was the worse wages I ever made (I was given a poverty level salary with the hopes thta bonuses could make up the difference... it did not.. bonuses were more like a few hundred dollars every now and then) and I worked 60+ hour weeks with a case load of 80-120. Most of the hours I worked (travel.. documentation... etc), could not be billed but were required of me due to state regulations etc.... So, good luck...!!!

My advice to you is that if you have no choice, do the job and see how big or small your first pay check is or is not, then go from there. Who knows, you may experience something positive......? I personally will neever work a production/billing job again!

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

If they are only paying you for billable time, you need to figure out how to maximize that (within ethical limits). For example, do they have a standard for what a monthly report is billed? If it's normally 1.0 hours, then even if you figure out an incredibly efficient way to generate your monthly reports, they will probably tell you that you can still bill that 1.0 for it. They will certainly be billing their client for that much. You will also find that you will learn very quickly how to handle more work, i.e., more billables.

In my first "billable hours" job, they paid us for 37.5 hours per full-time week regardless, and if we billed more than 200 hours per month, we got bonuses. Most of us found it very easy to bill 50+ hours per week while actually working 37.5 or so. I started at 20 hours per week and figured out how to bill more than 20 hours within less than two weeks. She's right, you can manage a bigger case load with practice, so don't think that your first biweekly paycheck is the final answer to the question of how much you will earn.

biz36

13 Posts

Thank you for your feedback MBARNBSN. I agree it's not the most secure financial option, but it has been the only offer in case management I have been able to get. I have 7 years of experience including hospital (Neuro/Spine/Ortho/Stroke/Urology/Epilepsy/Progressive Care) and home infusion. I have interviewed with multiple case management companies over the last year, but they always want more experience. I am willing to work contingent on the side for extra income to make up for potential loss of wages with the billable hours. I really want to get into case management and obtain my CCM when I have enough hours under my belt. I feel like this is my only option and I'm willing to sacrifice a set income in order to get the experience to move on and find a more secure job in case management later. Am I ridiculous to think this way? You have been in case management for many years, is it worth the sacrifice?

biz36

13 Posts

GrnTea, thank you for commenting. The company I interviewed with is a smaller company with only 8 case managers and specializes in catastrophic auto injuries. So, we are not offered a base set of paid hours like you mentioned and no bonus structure. The more I research the various companies, I see how varied the salaries are. I did speak to two case managers at the job I'm contemplating and they said it is easy to bill enough hours to make a 40 hour work week. One of the case managers is moving out of state so I will be getting all of her cases transferred to me, so I have the potential to get some steady hours once I'm up and running. How long did it take you to feel comfortable and competent with the case management role and billing appropriately?

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.
I feel like this is my only option and I'm willing to sacrifice a set income in order to get the experience to move on and find a more secure job in case management later. Am I ridiculous to think this way? You have been in case management for many years, is it worth the sacrifice?

No, you are not ridiculous. Maybe insane? :) On the other hand, so am I. In fact I would probably do the same if I was trying very hard to break into this field without work experience. I tend to go to extremes to get what I want careerwise too.

After reading GrnTea's post and thinking back on my experience, my job satisfaction would not have been as bad if my case load was smaller and if I could have made more money in terms of salary and bonuses! So, do what you have to do to gain experience and network with recruiters so you can move on when the time comes. Good luck! :)

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

GrnTea, thank you for commenting. The company I interviewed with is a smaller company with only 8 case managers and specializes in catastrophic auto injuries. So, we are not offered a base set of paid hours like you mentioned and no bonus structure. The more I research the various companies, I see how varied the salaries are. I did speak to two case managers at the job I'm contemplating and they said it is easy to bill enough hours to make a 40 hour work week. One of the case managers is moving out of state so I will be getting all of her cases transferred to me, so I have the potential to get some steady hours once I'm up and running. How long did it take you to feel comfortable and competent with the case management role and billing appropriately?

I think it takes a minimum of four months to feel vaguely competent in any new job-- I think I read that somewhere. You won't be doing your billing in a vacuum, anyway-- you will have a supervisor to check your work and be sure you're getting "credit" for what you do. Remember, your billing translates into the bills they send the clients. However, I think a few weeks orientation will be fine for you-- you sound intelligent and thoughtful, and your writing skills far exceed many folks'. :)

You may find some clients that have the dread "special handling instructions," or whatever they call it. These are the ones that say things like, "No billing for calls to / from the adjusters," "Maximum of .5 for a monthly report (even if it takes you all afternoon)," "Half-time paid for travel time," and the like. You just learn to deal c it, like anything else.

Never fear, your supervisor or peers will help you c all this.