salary plus billing options

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I just got offered a position to join a Pulmonary Critical Care group at a large, tertiary hospital. I was told a salary amount, but I was also told that NPs do their own billing for procedures (central lines, alines, thoras, etc...). Am I correct to think the amount billed would be additional income?

Does anyone else use this type of pay structure? If so, how do you like it?

Thanks!

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I just got offered a position to join a Pulmonary Critical Care group at a large, tertiary hospital. I was told a salary amount, but I was also told that NPs do their own billing for procedures (central lines, alines, thoras, etc...). Am I correct to think the amount billed would be additional income?

Does anyone else use this type of pay structure? If so, how do you like it?

Thanks!

You should clarify the pay structure. Procedures cannot be supervised by physicians so they have to be billed under your NPI. Thats how I would read the statement. I bill for all my procedures as well as E/M and critical care. I don't get money for this besides the salary.

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Ok, so we bill for it, but our salary is the lone form of income? We bill in order for the hospital to get reimbursed? Geez, my salary stinks then...

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Ok, so we bill for it, but our salary is the lone form of income? We bill in order for the hospital to get reimbursed? Geez, my salary stinks then...

Just out of curiosity how much do you think these reimburse? Its unlikely that the hospital makes money off you if you are at a tertiary hospital. One the other hand if you don't cover your salary should you owe them money? The advantage of salary is it takes financial incentive out of billing and allows you to make decisions based on whats right for the patient.

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I was thinking the reimbursement would be a couple hundred bucks. Nothing crazy. I don't expect that to cover my salary. I was hoping that it would have been a small boost to my income, that's all.

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I was thinking the reimbursement would be a couple hundred bucks. Nothing crazy. I don't expect that to cover my salary. I was hoping that it would have been a small boost to my income, that's all.

I guess I don't understand why you expect a boost to your income if you aren't covering your salary. They are paying your salary, procedures are part of your job therefore you are being paid for doing procedures. In reality you don't get a lot from procedures compared to critical care billing.

Lets say you are working a 12 hour shift. In our institution the expectation that you will provide 75% of your time in patient care. This allows you three hours to go to the bathroom eat lunch etc. Some days your patient load is light and you might have six hours. Other days you miss lunch etc and you work 12 hours. Overall it balances out. Generally if you are hitting 75% patient care time your billable time is around 65% (50% at night). So you have 7.8 hours of billable time. We average 3.8 RVUs per hour so that works out to around 30 RVUs. We are paid $41/hour per blended RVU so we bring in around $1200 per day. Lets say an average of $60 per hour (southeast large city). We are paid $720 so that looks like a nice profit. However, add another 25% for benefits and 10% for administrative expenses. This works out to around $1000 per day so our "profit" is $200. But wait, our night crew only bills around 6 hours so thats $931 so we lose $70 per day on them. Then we have to pay extra to cover vacations etc so overall we break even.

However, thats for a SICU which is one of the most profitable. Lets looks at our MICU. Same math but their blended RVU is only $34 so they bring in so thats $1007 per day and $775 per night. So we lose $217 per day. In our urban safety net MICU its even worse.

Now for procedures

Lets take CVL with US 2.5 RVUs + 0.3 for the US for a total of 2.8 RVUs. At Medicare reimbursement of $35 per RVU you are talking about $98. So if you can do it in 15 minutes that works out to $400 per hour. However in the real world where you have to get the stuff, consent the patient and clean up its more like 45 minutes. So now you are talking about $127 per hour. You would be better off doing critical care at $157 per hour. Now if you have lots of private insurance then that's different but when you are talking large tertiary hospital this is the reality.

Also I can drop in a central line in 10 minutes in an emergency but I've been doing this for a while. You haven't so every thing you do is going to take longer and be less efficient. Despite this you will be paid the same not penalized for being less efficient.

Fundamentally you are being hired to do pulm critical care and procedures because you cost less (and require less subsidy) than a physician.In our model the APPs do 60% of the billing and require little subsidy.

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There are folks out there that do exactly what you described and make a killing doing it. I interviewed one in the ED/UC setting but has negotiated this structure in the CC setting. It's on podcast or here's a link to the episode npmoneyshow.podbean.com

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I am new to understanding the world of rvu's as a new grad. I also am new to understanding incident to billing, etc., and I wasn't sure if that fell under that umbrella. I don't consider doing procedures as the only way to cover my salary. Thanks for the info

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