Four Patients Per Hour And Time Based Billing

[SaturnNP, MSN, NP]

How do you bill level 3 or 4 patients if you expect to see four patients per hour?

I am negotiating a contract with an Urgent Care and will be paid hourly with no RVU bonuses.

Thank you.

[djmatte, ADN, MSN, RN, NP]

I’m presuming you don’t Bill by time.  You Bill by complexity. You will also add a S9088/3 if non-Medicare and CPT code for any procedures. 

In primary care, we can more easily Bill for time on any pre charting or chart evaluation before or after the visit. Not so easy in an urgent care situation. 

[MentalKlarity, BSN, NP]

If you’re paid by the hour with no bonuses who cares how you bill? You’re not going to see any of it.

[djmatte, ADN, MSN, RN, NP]

55 minutes ago, MentalKlarity said:

If you’re paid by the hour with no bonuses who cares how you bill? You’re not going to see any of it.

Probably helps to gauge appropriate pay. If you know what they’re bringing in, you know what you can ask for. 

[MentalKlarity, BSN, NP]

4 hours ago, djmatte said:

Probably helps to gauge appropriate pay. If you know what they’re bringing in, you know what you can ask for. 

Would love this to be true, in reality I’ve rarely met an NP who advocates for themselves. I often see those billing 300-400K annually while being paid $95K with 2 weeks vacation and 50 hour work weeks. Makes me want to open my own practice and employ NPs exclusively hahaha

[umbdude, MSN, APRN]

I work for and interviewed a number of NP-owned practices. They're not much better. Hence I started my own.

There's a ton of work and financial risks that come with starting a practice, then the op expenses pile up as it grows. These aren't shared by employees or 1099s. So unless the employee or contractor is bringing in their own full panel from day 1, I wouldn't compensate them much more than market rate.

[ZyzzFan]

1 hour ago, umbdude said:

I work for and interviewed a number of NP-owned practices. They're not much better. Hence I started my own.

There's a ton of work and financial risks that come with starting a practice, then the op expenses pile up as it grows. These aren't shared by employees or 1099s. So unless the employee or contractor is bringing in their own full panel from day 1, I wouldn't compensate them much more than market rate.

Depends what private practice you start

It only took me around $8000 to start my Psych practice and my overhead is $2000/month which takes 7 hours of patient care to recoup.  

Urgent care is another beast though.  Xray machines, meds, ekg machine, tests, etc,  no thanks 

[SaturnNP, MSN, NP]

Thank you for all of your responses!

Here is the hypothetical situation. I am an hourly employee and bill based on time. It does not need to be an Urgent care setting. 
I get paid for 8 hours but bill the patients for that day for 10 hours. 
Could it be considered a labor law violation if I am underpaid? 
Could it be an insurance fraud if these times do not match? 

Thank you. 

[djmatte, ADN, MSN, RN, NP]

SaturnNP said:

Thank you for all of your responses!

Here is the hypothetical situation. I am an hourly employee and bill based on time. It does not need to be an Urgent care setting. 
I get paid for 8 hours but bill the patients for that day for 10 hours. 
Could it be considered a labor law violation if I am underpaid? 
Could it be an insurance fraud if these times do not match? 

Thank you. 

Billing on time IMO is a slippery slope, but it's becoming the norm. The point of it is to allow for the flexibility to Bill for that random patient they turned into a 40 minute visit despite the patient not being super complex from a diagnosis perspective. Changes to CMS is allowing providers to factor in research, documentation, or other visits-related tasks into time. So you see more notes that say "x minutes of this visit related to (…..)”.

 If you're truly spending two hours more than you actually work and can justify the time billing then cool. But true complexity IMO is easier to capture in a situation share you're seeing 4/hour. When insurance companies start seeing the traditional 45/45 split of 213/214 visits balloon to 80% 214s, you're gonna see the industry clap back fast or further scrutinize/reduce reimbursement.