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RVU reimbursement rates
Hi guys, I’m looking at different positions and I usually ask what the RVU reimbursement rates are, how many RVUs per hour are expected and the worklist composition as ways to get a more granular idea of work flow and efficiency. I know this might come across a little tacky but the market is so flooded with positions right now I’m just trying to have some way of organizing jobs into different tiers.
Sometimes when I’ve asked this question I’ve gotten the response that the practice does not use RVUs and instead the practice lists different dollar amounts per study (ie. a specific percentage of net revenue). Something like the following:
CT Brain Average pay 20.00[u][/u][u][/u]
CT A/P Average pay: 30.00[u][/u][u][/u]
CT CAP: Average pay: 40.00[u][/u][u][/u]
MR L spine: pay 30.00[u][/u][u][/u]
MR Brain: pay 30.00
Is there somewhere I can find “standard” reimbursement rate for these studies (ie. what insurance pays, which I assume is indirectly based on what Medicare/Medicaid pay)?
Also it seems like using just RVUs can be a bit unreliable (sort of like using BMI to tell a bodybuilder with 2% bodyfat that they’re overweight). For example, if a practice is all x-rays, getting to a certain number of RVUs seem like it would require more legwork (for me at least) than a practice that’s all MRIs. And not to mention the case complexity can vary so much depending on the patient population.
So what I’m really asking more than anything is — do you all have recommendations for how to compare salaries and job context? Or any tips on pitfalls to look out for?
You guys seem unusually business savvy so just would appreciate tips on how to better see the forest from the trees.
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48 Replies
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Very low numbers
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I think he was using those numbers as an example. Not the actual rates hes seen. I may be mistaken.
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So to make $3000, you need to read 100 brain MRIs.
Just kill me now. And brain MRIs are one of the easiest RVUs to get besides mammo.
In this great job market, this is what you came up with? Really?
The average RVU for con MRI brain and noncon MRI brain is 2.0. Thats $15 per RVU. You managed to find the lowest paying job in America.-
Quote from W24
The average RVU for con MRI brain and noncon MRI brain is 2.0. Thats $15 per RVU.
According to this table from a google search, MRI brains are 4.65 RVUs each?
[link=https://www.acr.org/-/media/ACR/NOINDEX/Advocacy/Advocacy-News/2022-MPFS/Impact-Table-70000-Series.pdf]https://www.acr.org/-/med…Table-70000-Series.pdf[/link]
But then this table suggests different RVU rates, which seem a little more consistent with what you stated:
[link=https://wiki.radiology.wisc.edu/index.php/File:RVU_Table_v5.xlsx]https://wiki.radiology.wi…File:RVU_Table_v5.xlsx[/link]
Is the latter table more accurate?
Interestingly it seems that RVU rates have dropped 44% over the last decade for radiology according to this article:
[link=https://www.sciencedirect.com/science/article/pii/S0363018822000081]https://www.sciencedirect…/pii/S0363018822000081[/link]
Good times.
Where can I find a comprehensive list of accurate RVU rates for different exams?-
And also, yes unfortunately these were pretty close to the actual numbers that a group I interviewed with sent me. It was also a per diem position without any associated benefits and they charged $2500/year rental fees for their workstations. Pretty wild.
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LOL
You should take it!
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If you look at the ACR table you linked, each exam is listed 3x. The 2nd and 3rd listing has modifiers 26 and TC, respectively. The 1st listing is the global bill RVU and Medicare payment. The 26 modifier is the professional component (payment for read) and the TC modifier is the technical component (payment to perform exam). Tele jobs typically only bill professional. If a group owns an imaging center they will global bill for exam.
Private insurance will typically pay 1.2x to 1.6x Medicare rates.
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Quote from burton_rads
If you look at the ACR table you linked, each exam is listed 3x. The 2nd and 3rd listing has modifiers 26 and TC, respectively. The 1st listing is the global bill RVU and Medicare payment. The 26 modifier is the professional component (payment for read) and the TC modifier is the technical component (payment to perform exam). Tele jobs typically only bill professional. If a group owns an imaging center they will global bill for exam.
Private insurance will typically pay 1.2x to 1.6x Medicare rates.
Very helpful, thank you. Does that mean that private insured groups should be paying [1.2 to 1.6 x $32/rvu] — ie $38-52/RVU)?-
Quote from white_epidermoid
Quote from burton_rads
If you look at the ACR table you linked, each exam is listed 3x. The 2nd and 3rd listing has modifiers 26 and TC, respectively. The 1st listing is the global bill RVU and Medicare payment. The 26 modifier is the professional component (payment for read) and the TC modifier is the technical component (payment to perform exam). Tele jobs typically only bill professional. If a group owns an imaging center they will global bill for exam.
Private insurance will typically pay 1.2x to 1.6x Medicare rates.
Very helpful, thank you. Does that mean that private insured groups should be paying [1.2 to 1.6 x $32/rvu] — ie $38-52/RVU)?
No. it does not mean that.
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Quote from drad123
Quote from white_epidermoid
Quote from burton_rads
If you look at the ACR table you linked, each exam is listed 3x. The 2nd and 3rd listing has modifiers 26 and TC, respectively. The 1st listing is the global bill RVU and Medicare payment. The 26 modifier is the professional component (payment for read) and the TC modifier is the technical component (payment to perform exam). Tele jobs typically only bill professional. If a group owns an imaging center they will global bill for exam.
Private insurance will typically pay 1.2x to 1.6x Medicare rates.
Very helpful, thank you. Does that mean that private insured groups should be paying [1.2 to 1.6 x $32/rvu] — ie $38-52/RVU)?
No. it does not mean that.
Then what is a fair RVU reimbursement rate?-
How much are PP groups getting $ per rvu wise in billing before expenses?
Our PP group makes 57 which I think could be better. Got worse in 2022. Used to be 60.
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57 is pretty good. the cuts are real.
You can get stipends for a few bucks higher but the asinine thing is you cant set high rates due to Stark laws.
Basically anything you think of to stave off cuts or make money, the lawyers and government have already thought of and will make sure you can’t do it. -
Quote from sartoriusBIG
How much are PP groups getting $ per rvu wise in billing before expenses?
Our PP group makes 57 which I think could be better. Got worse in 2022. Used to be 60.
50-70 for PP according to Dan Corbett
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so what are they getting after expenses
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7 percent is typical expenses.
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7% for all overhead in a true PP?
That would be amazing. Ive always seen like $12-15/rvu after billing, IT, payroll, insurance, etc.
I suppose it could be a lot less if you’re a hybrid PP with a hospital system.
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The average Radiologist (and all doctors) is grossly underpaid. This is a taboo topic because we are still paid relatively well compared to other professions and we are doing our jobs for the good of humanity – so we are just supposed to shut up and accept it. The easiest way to “right-size” the salaries of doctors is to decrease RVU reimbursements, slowly over time and let the annual salaries remain essentially stagnant over decades (with perhaps minimal increases YOY). Many PP rads 20-25 years ago were making $600K — which is probably similar ballpark nowadays. Some may make less in competitive markets or with bloated admins. Some may make more by higher volumes, great payor mix, or ownership of equipment (which isn’t really salary but a side-business opportunity). If salaries kept up with inflation, reasonable/appropriate pay probably should be:
Academic – $750K
Hospital employed – $1M
PP -$1.2M+
This may seem high but it’s probably not even adjusting for the absurd volumes we read. Even if you take into account the ability to read more because of efficiencies like PACS, there is a limit to how much data the human brain/mind/eye should and can process. If we mention or talk about these very fair, IMO, numbers we come across as greedy or entitled. But that money is now being ciphered to the suits and we unfortunately are forced to accept it.
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Yeah. Nothing will change unless physicians unionize. Even that has the potential to create public backlash. Like you said, nobody feels sorry for the doctors making 500k+. Harder and harder to justify the tuition and opportunity cost to become a physician. Private med school grads are now taking out 600k+ for tuition and cost of living. At what point do people just say its not worth it.
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Quote from ChuckI
The average Radiologist (and all doctors) is grossly underpaid. This is a taboo topic because we are still paid relatively well compared to other professions and we are doing our jobs for the good of humanity – so we are just supposed to shut up and accept it. The easiest way to “right-size” the salaries of doctors is to decrease RVU reimbursements, slowly over time and let the annual salaries remain essentially stagnant over decades (with perhaps minimal increases YOY). Many PP rads 20-25 years ago were making $600K — which is probably similar ballpark nowadays. Some may make less in competitive markets or with bloated admins. Some may make more by higher volumes, great payor mix, or ownership of equipment (which isn’t really salary but a side-business opportunity). If salaries kept up with inflation, reasonable/appropriate pay probably should be:
Academic – $750K
Hospital employed – $1M
PP -$1.2M+This may seem high but it’s probably not even adjusting for the absurd volumes we read. Even if you take into account the ability to read more because of efficiencies like PACS, there is a limit to how much data the human brain/mind/eye should and can process. If we mention or talk about these very fair, IMO, numbers we come across as greedy or entitled. But that money is now being ciphered to the suits and we unfortunately are forced to accept it.
Yes… a doc in the 90’s making 650-700K reading 50 xrays, 5 CT and 2 MRI was living large! Can’t imagine
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Well, this is not just isolated to radiologists or doctors in general. This is part of the American decline.
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Quote from TurboEcho
Quote from ChuckI
The average Radiologist (and all doctors) is grossly underpaid. This is a taboo topic because we are still paid relatively well compared to other professions and we are doing our jobs for the good of humanity – so we are just supposed to shut up and accept it. The easiest way to “right-size” the salaries of doctors is to decrease RVU reimbursements, slowly over time and let the annual salaries remain essentially stagnant over decades (with perhaps minimal increases YOY). Many PP rads 20-25 years ago were making $600K — which is probably similar ballpark nowadays. Some may make less in competitive markets or with bloated admins. Some may make more by higher volumes, great payor mix, or ownership of equipment (which isn’t really salary but a side-business opportunity). If salaries kept up with inflation, reasonable/appropriate pay probably should be:
Academic – $750K
Hospital employed – $1M
PP -$1.2M+This may seem high but it’s probably not even adjusting for the absurd volumes we read. Even if you take into account the ability to read more because of efficiencies like PACS, there is a limit to how much data the human brain/mind/eye should and can process. If we mention or talk about these very fair, IMO, numbers we come across as greedy or entitled. But that money is now being ciphered to the suits and we unfortunately are forced to accept it.
Yes… a doc in the 90’s making 650-700K reading 50 xrays, 5 CT and 2 MRI was living large! Can’t imagine
When I was a fellow one of my attendings told me that he started out as an associate in PP during mid/late 90s making in the 150k range with parters making in the 350k range. Of course they were making more per wRVU -
350K in 1995 is worth 700k in today’s dollars.
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Quote from 9000tesla
350K in 1995 is worth 700k in today’s dollars.
Wow. I made about $20/hour as a waiter/bartender back then. $40 today would be pretty solid given that entry level KFC jobs are offering $12-14/hour -
Even if those numbers were true, $1 bought you about 3X more in the 1990s.
What I’ve heard, is partners in the 90s were making 7 figures in that days money. ie > 2MM equivalent today -
Partners in my group made the same average salary in 2006 as 2022 and did 30% more rvu in 2022.
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Quote from Cubsfan10
Partners in my group made the same average salary in 2006 as 2022 and did 30% more rvu in 2022.
Sounds about right -
Hospital administrator salaries seem to have gone up
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Quote from xraygiggles
Hospital administrator salaries seem to have gone up
Definitely. Their sear volume also seems to keep growing -
Yes I am satisfied with my gig due to ample time off to explore other interests and I enjoy reading a lot, which requires free time and decent head space free. However – I do believe I am underpaid relative to what I bring to the table. I consciously accept this however due to not prioritizing money any longer.
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My real estate passive income / exits brought $190K net after taxes each of the last 2 tax years (and growing). I can only manage to spend about $40-50K per year total living expenses now that I am overseas, travel a lot, but no longer have a $3K per month rent. I try hard to spend a lot of money, but the fancy hotels and business class flights are mostly free due to credit card rewards points / travel hacking.
So you think I would ever need more than $250K passive income if I have kids? I won’t raise them in an expensive Western country. When I say passive since my real estate is mostly in LP syndications it takes up less than 10-15 hours PER YEAR of my time. If I have a wife that doesn’t work plus 2 kids do you think my living expenses would more than 5 X? -
Quote from Re3iRtH
Even if those numbers were true, $1 bought you about 3X more in the 1990s.
What I’ve heard, is partners in the 90s were making 7 figures in that days money. ie > 2MM equivalent today
Partners making 7 figures in the 90s had to own equipment. This no longer makes financial sense.
Probably most careers in the US have not kept up with inflation. This is not unique to rads/physicians. For us this is due to CMS cuts/budget neutrality. AMA (and many others such as ACR) are trying to change this. I suggest joining the both. No real other options. Otherwise this cycle continues -
Fully agree. Goes hand in hand with us accepting cuts/PE jobs/no stipends because we “make enough.”
Try telling a PP ortho or ENT these large incomes are outlandish or unjustified, they likely wouldn’t work for much less. In fact, they choose not too, as many community hospitals have no ortho, ENT, GI call coverage because they won’t even take call for less than $1500/day.
Hard to argue with the volumes we read in PP that we are adequately compensated at $600k. The $/wRVU metric has been created to obfuscate this fact. -
Quote from cabowabo
Fully agree. Goes hand in hand with us accepting cuts/PE jobs/no stipends because we “make enough.”
Try telling a PP ortho or ENT these large incomes are outlandish or unjustified, they likely wouldn’t work for much less. In fact, they choose not too, as many community hospitals have no ortho, ENT, GI call coverage because they won’t even take call for less than $1500/day.
Hard to argue with the volumes we read in PP that we are adequately compensated at $600k. The $/wRVU metric has been created to obfuscate this fact.
Ortho/ENT take CMS cuts just as we do. Orthopods/ENTs at the HC system we cover are employed. Pretty sure our PP group does just as well if not better (esp when you throw in benefits etc), def have better health insurance and more time off…PP orthopods work pretty damn hard, market is actually tight for them as well. How many pts you think they see in clinic? Freakin painful. Mid-levels prob help big time -
spot on
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Quote from OnsiteRad
7 percent is typical expenses.
That would be a common billing company charge. There are very few practice situations where that would be your only overhead expense. Depending on where you are, you are going to have additional expenses for medmal insurance and if you bill for your own services (as opposed to having the hospital bill global), you are going to need someone who takes care of contracting. 20% would be a more typical overhead.
So lets say across the board, your practice collects $57/wRVU on professional charges. After a 20% overhead, everyone should go home with $45.60/wRVU. That’s for a purely professional fee based practice. No additional revenue sources or money sinkholes.
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Quote from fw
Quote from OnsiteRad
7 percent is typical expenses.
That would be a common billing company charge. There are very few practice situations where that would be your only overhead expense. Depending on where you are, you are going to have additional expenses for medmal insurance and if you bill for your own services (as opposed to having the hospital bill global), you are going to need someone who takes care of contracting. 20% would be a more typical overhead.
So lets say across the board, your practice collects $57/wRVU on professional charges. After a 20% overhead, everyone should go home with $45.60/wRVU. That’s for a purely professional fee based practice. No additional revenue sources or money sinkholes.
What is contracting costs?
I didn’t include medmal insurance in the expenses.
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I agree that we Rads are grossly underpaid. I actually feel quite underpaid but don’t really want to work harder either at this point in my life….. -
Quote from Waduh Dong
I agree that we Rads are grossly underpaid. I actually feel quite underpaid but don’t really want to work harder either at this point in my life…..
I got the impression that you were really satisfied with your job…I waver on this particular topic. Most of the time I feel adequately compensated (think our group is around $65/wRVU). I swing the other way after a rough call shift after dealing with a bunch of positive/complex cases (trauma etc), calling in critical results, disruptions from techs etc…Regardless the whole concept is relative/subjective…It is bothersome that physicians as a whole have received never ending cuts from CMS while Hospital systems continue to increase their reimbursement. -
Quote from OnsiteRad
What is contracting costs?
– Negotiating payor contracts so you dont end up getting the 60% medicare they are going to offer you if you just sign whatever they put in front of you.
– Auditing what you DO get paid to make sure you get paid according to your contract and not some lower rate some insurers will drop back to ‘accidentally’.
– Negotiate contracts with entities like workmans comp insurers, prison medical contractors and large employers (occ health) etc.
I didn’t include medmal insurance in the expenses.
Yeah, but that’s part of your overhead. So is health, disability and general commercial liability, state and local business taxes etc. The 7% is going to be what a billing company charges you for claims transmission, lockbox service and maybe 1st level appeals/reconsiderations. Unless you do all the other stuff yourself (which you can certainly do for a 1-man shop), you are going to hire someone to do it. So you either pay someone a salary, or you contract with a practice management company to do this. It’s gonna cost more than 7%. -
How do private practices go about increasing their $/wRVU?
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Quote from api7342
How do private practices go about increasing their $/wRVU?
The .gov payers (Medicare, Tricare etc.) are what they are. With private insurers you can push for higher reimbursements. One way to do that i to cancel their contract every time it comes up for renewal and to only sign if they up the pay. If they let it expire, their subscribers start getting hammered with out of network charges for imaging that they had little choice of where to get. Subscribers complain to their employer bout their shitty health insurance and the state insurance commissioner etc. You won’t make many friends but after some bluffing and bloviation the insurers will up the offer to get you to come back into the fold.
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Quote from fw
Quote from OnsiteRad
What is contracting costs?
– Negotiating payor contracts so you dont end up getting the 60% medicare they are going to offer you if you just sign whatever they put in front of you.
– Auditing what you DO get paid to make sure you get paid according to your contract and not some lower rate some insurers will drop back to ‘accidentally’.
– Negotiate contracts with entities like workmans comp insurers, prison medical contractors and large employers (occ health) etc.I didn’t include medmal insurance in the expenses.
Yeah, but that’s part of your overhead. So is health, disability and general commercial liability, state and local business taxes etc. The 7% is going to be what a billing company charges you for claims transmission, lockbox service and maybe 1st level appeals/reconsiderations. Unless you do all the other stuff yourself (which you can certainly do for a 1-man shop), you are going to hire someone to do it. So you either pay someone a salary, or you contract with a practice management company to do this. It’s gonna cost more than 7%.
OK. Thanks.
The law office that we work with and our billing company charge us per hour for negotiations or any extra work. It does not cost us more than 2% per year on average. If it is the year that we are renewing our major hospital contract it is a lot more but we don’t negotiate hospital contract every year.
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The number of threads on how RVUs work is a reflection of what is so wrong with RVUs. If youre going to use RVUs, make it transparent, especially for those that actually produce the RVUs!
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Quote from W24
The number of threads on how RVUs work is a reflection of what is so wrong with RVUs. If youre going to use RVUs, make it transparent, especially for those that actually produce the RVUs!
It’s a reflection of what a piss-poor job most residencies do to explain how this all works. I was lucky in that we had both a rotation with a private group and ‘community faculty’ who would come in for some of the resident lectures. One of them had a equipment owning practice. He took some of his lecture time to explain to us how radiology is reimbursed, what a joint venture is, how contracts and preapprovals work etc. RVUs are actually one of the easier things to grasp.
But that’s a general thing with medical schools and residencies. Money is treated as something icky that we better leave to the men in suits to handle and then we are suprised if those suits take a big bite out of our earnings. -
Quote from fw
Quote from W24
The number of threads on how RVUs work is a reflection of what is so wrong with RVUs. If youre going to use RVUs, make it transparent, especially for those that actually produce the RVUs!
It’s a reflection of what a piss-poor job most residencies do to explain how this all works. I was lucky in that we had both a rotation with a private group and ‘community faculty’ who would come in for some of the resident lectures. One of them had a equipment owning practice. He took some of his lecture time to explain to us how radiology is reimbursed, what a joint venture is, how contracts and preapprovals work etc. RVUs are actually one of the easier things to grasp.
But that’s a general thing with medical schools and residencies. Money is treated as something icky that we better leave to the men in suits to handle and then we are suprised if those suits take a big bite out of our earnings.
Well said. When interviewing at any job, what a group is getting per wRVU should def be asked. I’ve had a handful of different jobs and never asked about this. -
Quote from Rad8tr
so what are they getting after expenses
Unsure but the 50-70 is for wRVU only I believe, so you still have the other components of the pro-fee which would bump up the total pro component. Below is an example from fw I believe, also think he clarified this was for CT a/p with and without:
Lets say we look at CPT 74178-26, the professional fee for a CT Abdomen pelvis with.
If you select ‘Relative Value Units’ and ‘-26’, it tells you that the
wRVU is 2.01
PE-RVU is 0.72
Malpractice RVU is 0.09
Total professional component: 2.82 RVU
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Quote from W24
So to make $3000, you need to read 100 brain MRIs.
Just kill me now. And brain MRIs are one of the easiest RVUs to get besides mammo.In this great job market, this is what you came up with? Really?
The average RVU for con MRI brain and noncon MRI brain is 2.0. Thats $15 per RVU. [b]You managed to find the lowest paying job in America. [/b]
Thats quite an achievement in this job market, deserves some type of award, no?
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OP, youre over thinking this. Just go out and find a job you like.
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