Knowledge Expansion

CPT and wRVU benchmarking for better productivity and revenue

Insight Article

Benchmarking & Forecasting

RVUs

Coding & Documentation

Andrew Hajde CMPE
To kick off the new MGMA DataDive Digest, a monthly newsletter exploring the unique and powerful ways that healthcare leaders use data in their organizations, I had the pleasure of talking with one of MGMA’s newest employees: Lauren Jones, data strategist.

Lauren has a background as a practice manager, including eight years with a group of general surgeons. We recently talked about the relationship between CPTs and RVUs and how that can impact practice revenues, as higher RVUs generally equate to higher compensation and increase net revenues for a practice. 

Lauren noted that she often would sit with the practice’s surgeons and go over their RVUs and how they correspond to CPT codes while reviewing revenues and the benchmarks to which the physicians were held. Along those lines, the MGMA DataDive Procedural Profile allows organizations and practices to benchmark their providers at the CPT-code-level across both commercial and federal payers for practices who contribute that data to MGMA. 

That relationship between CPTs, wRVUs and revenue for providers, since both administrators and clinicians should pay attention to what's charged, both from an E/M visit standpoint but also for surgical and other procedures.

"It's really important that this is a focal point for administrators and clinicians," Jones said, noting the potential for undercoding and/or overcoding between physicians in practices. "If they're undercoding with those CPT codes, maybe their RVUs are low and then the revenue is actually lower."

When it comes to surgical procedures, Jones noted the value of making sure that anyone coding for surgeons captures all the CPTs associated with them. "You could have a situation where two doctors can do the exact same surgery, and if they coded a little differently, that can cause that little bit of a difference in their RVUs or the revenue coming in," Jones said. 

For example: If a chest tube is coded separate from the rest of a surgery, it can create a difference of a couple thousand dollars for the same surgery without that separate coding, not to mention an RVU differential. To that end, it's important for a certified coder to then have a discussion with physicians to ensure they recognize when these differences occur to be resolved through sharing coding best practices.

When practices then benchmark those CPT codes, it provides an opportunity to look beyond those internal discussions and refocus to become more productive and produce higher revenues. "Sometimes when you're working in your own practice, and you're focusing on what you need to do, you kind of lose sight on what your peers may be doing," Jones said. Knowing how some competitors are doing in their coding "allows you to become more competitive," she added.

Knowing what your peers are charging and the types of services they're performing at specific levels and CPT codes can tip your practice off to alternative methods of care delivery that can be implemented within your group and provide more RVUs and revenue along with it, Jones noted.
And with any coding, Jones reminded that accuracy is a primary concern so that there aren't any missed revenue opportunities or issues with the patient record. While Jones said that coding variances can happen via "honest mistake," discovering those variances is an opportunity for identifying improvements in education and processes/workflows. That work ultimately will help providers reach the top quartile of productivity and, in the process, improve overall revenues for the practice.

"You want to try to capture every opportunity that you can," Jones said.
 

About the Author

Andrew Hajde
Andrew Hajde CMPE
Assistant Director, Association Content MGMA Englewood, Colorado
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