L3000 in a wRVU setting

[toejamm]

Longtime lurker, first time poster.

I'm in an employed position and adding custom orthotics to the clinic. Patients ask daily, and it's a marketable service line.

As L3000 is an HCPCS code with no assigned RVU, I'm looking to negotiate some portion of the revenue generated to my employer from an orthotic program. Our DME is contracted out to a supply company so there is no precedent.

Does anybody out there in an employed position have experience negotiating a conversion of DME or orthotic revenue into an wRVU structure?

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[PatchAdamsFan]

My colleagues in various MSG groups negotiated anywhere from 0% profit sharing (they didn't go for it) to 50%. It is difficult to put an wRVU number on CFO specifically due to their variability in material/price, but I would start by pulling the fee schedule and comparing a wRVU procedure code which most closely matches the price of the CFO and go from there. To be honest, I don't bother with orthotics - yes a high demand but patients have no problem being referred out and it saves me the headache of arguing the price and why their insurance won't cover them. Also unless you're using a quick scan, your time in an RVU model is better spent elsewhere.

 

[deleted1149159]

Longtime lurker, first time poster.

I'm in an employed position and adding custom orthotics to the clinic. Patients ask daily, and it's a marketable service line.

As L3000 is an HCPCS code with no assigned RVU, I'm looking to negotiate some portion of the revenue generated to my employer from an orthotic program. Our DME is contracted out to a supply company so there is no precedent.

Does anybody out there in an employed position have experience negotiating a conversion of DME or orthotic revenue into an wRVU structure?

There are a couple of factors that would determine how to do this. If you practice in an area where orthotics are covered by insurance, then you can negotiate an RVU based on what the insurance reimburses. You would kind of have to do that if any local insurances cover orthotics. Billing for it, getting paid, then them giving you a check for the amount could be tricky. Again, if insurance, RVU it based on previous fees around the same reimbursement. Otherwise, if you are looking at pure cash, then you have to negotiate a percentage. And that is dependent on them agreeing to it, as mentioned.

 

[Feli]

Before anything else, make sure you code it correctly... common misconception here.

L3000 has at least a 10mm heel cup, extrinsic posts, etc... is that what you are really making? That's a thick custom orthotic, a UCBL, etc... NOT what 80% or more of pod office orthotics are (and real L3000 rarely fit into most shoes ppl actually wear). Those descriptions are more the things true custom DME shops tend to make.

L3020 description is what the vast majority of pod office orthotics (ProLab, etc etc) are... thin profile, shallow heel cup, maybe 3/4 length, no extrinsic posting, etc.

DME fraud is one of the top podiatry issues (upcoding, non-custom DME billed as custom, etc etc). It doesn't matter what your residency attending did or what Joe Flow DPM does or what you read in PM News. Code descriptions are code descriptions.

In 99% of PP, the HCPS code does not ultimately matter since it's 95+ percent cash pay for orthotics anyways. In RVU game, it very well might matter every single time. If you are sending orthotics to insurance or doing a PA, you want to best describe what you are doing, though.

...personally, I agree with above... send out orthotics whenever possible, esp if you get paid little or nothing for it. The customer service issues, the returns, the modifications, fair amount of MA training and errors on orthotics, shipping and storage hangups, etc etc get highly annoying. It also tends to break the doc-pt relationship if somebody is charged $300-500 cash by doc office for something they don't like... but not so much if you just Rx'd it and you send them back to the store for return/remake. It is also a good way to get a good relationship and your name out there with local DME store.

 

[air bud]

Zero reason to do custom in a RVU model. Send out. And 95 percent of people don't need custom anyways.

Edit 98 or 99%

 

[heybrother]

My residency clinic had charged $350 for custom orthotics for its entire history. The hospital for some reason decided to change the price to $1600. One of my attendings had a patient come in and ask for a pair. He had just heard the price changed. He told the patient to go to the orthotist. They refused and said they'd definitely pay. Got the bill for $1600. Refused to pay. Their kid was a billing specialist for somewhere else. Calls and is screaming at the people at the hospital. Starts trying to dissect the note and claim its fraud.

I think hospital people should enjoy their separation from the whole process, but the problem is you may be sending people off to get garbage. I had a lady come in with a pretty decent flatfoot today. Someone had sent her somewhere that had made her $400 essentially diabetic inserts that won't do crap. When I showed her my idea of a functional orthotic she was surprised by how different my stuff was from what she had.

 

[air bud]

My residency clinic had charged $350 for custom orthotics for its entire history. The hospital for some reason decided to change the price to $1600. One of my attendings had a patient come in and ask for a pair. He had just heard the price changed. He told the patient to go to the orthotist. They refused and said they'd definitely pay. Got the bill for $1600. Refused to pay. Their kid was a billing specialist for somewhere else. Calls and is screaming at the people at the hospital. Starts trying to dissect the note and claim its fraud.

I think hospital people should enjoy their separation from the whole process, but the problem is you may be sending people off to get garbage. I had a lady come in with a pretty decent flatfoot today. Someone had sent her somewhere that had made her $400 essentially diabetic inserts that won't do crap. When I showed her my idea of a functional orthotic she was surprised by how different my stuff was from what she had.

I mean I don't send them to the good feet store....I got a guy. He does good work. A relationship with an orthotist/prosthetist should go both ways.

 

[heybrother]

I mean I don't send them to the good feet store....I got a guy. He does good work. A relationship with an orthotist/prosthetist should go both ways.

Agreed. I've visited several of the orthotists in my town and was shown a diversity of quality offering. I now try to write them very open ended / use your judgement type prescriptions when I send in for AFOs and orthotics for patients that I don't want to make myself. In general pretty satisfied.

 

[Redsting]

I am wRVU model and send every single one out. Most do fine with some good OTC inserts.
People who pay cash are much more nit picky and will return and want it perfect and want you to alter it etc. Its not worth the time or hassle. I use one guy who is great for shoes, AFOs, orthotics, prosthetics etc. He will call once in a while and bounce ideas off me, but for the most part its all him.
I had someone come in that paid $1,000 for some crap at a shoe store. Maybe the headache would be worth it for that much a pair.