Wiki Incentivized Pay increase instead of base pay raise

[akfrog62@gmail.com]

I work for a small Ortho office. I have been employed 3-4 years with no pay increase. I am the ENTIRE billing department for this practice, coding, billing, patient collections, month end, credentialing, everything.
I approached the Manager about a raise after he indicted it would be ok. Based on my length of employment, the fact of no pay increase at all and the likelihood it would be a long time before another opportunity would surface, I asked for 15%. ( thinking they would counter with around 10-12%) Which breaks out to approximately 3-4% per year. After a week my Manager comes back and says instead of a base pay increase, he will put me on an ‘incentivized pay increase’. Meaning if I post $xxx per month in income, I will receive the monthly equivalent of 15% increase. If I do not post enough revenue I will receive my current amount for that month. He feels this is necessary for me to ’have some skin in the game’. I work hard, sometimes 6-7 days a week. I stress a lot about my job. No One knows my job, If I don’t do it, it doesn’t get done.
I have never heard of such a thing for a staff employee. I don’t know what to do with this! I’ve been in Medical for 20 years. Seen some stuff but this is a new one. Does anyone have any advice or insight on this?

 

[thomas7331]

It's hard to advise without knowing a little more about your situation and the market for the work you're doing in your geographical area, but I'll share a couple of thoughts. In my experience, if you simply ask for a raise instead of actually negotiating for one, you'll usually get a token increase if your employer likes your work and would prefer to keep you and try to make you happier rather than lose you. It sounds like that may be what is happening here. A productivity-based bonus is an unusual offer for a small practice, especially one where you're the only employee doing this particular job. However, you say that you're working 6-7 days a week, which suggests to me that they may be paying you a lot of overtime. If that's the case, then my guess is that the offer you're getting may be your employer telling you that if you can become more efficient, then they are willing to share the savings with you (i.e. they'll spend less on overtime, and you'll receive more pay for fewer hours). That may or may not be a realistic expectation and that's something probably only you can decide, but it's probably worth a try since it sounds like the new arrangement they're proposing won't result in a decrease in pay for you in either case.

My other suggestion is that if you think you are being underpaid and that the market value of the work you do is really more than what you're getting, then you need to negotiate from a stronger position. That might mean doing some interviews with other employers and getting some offers, or connecting with coders in your area to find out what other employers are offering, so that you can go to your employer and seriously let them know that if they want to keep you in the longer term, then they need to compensate you at a competitive rate. They may or may not be able to met your requirements, but at least when you're in a position such as that, you have much more leverage with an employer to work out the terms of your employment and find out how far they're willing to go to retain you than you would simply by asking for a pay increase.

Hope that may help some and good luck!

 

[csperoni]

I'll provide my opinion on this as well. It certainly is unusual for a fully employed biller/coder of a small practice to be paid on revenue. What if the physician takes a 2 week vacation? You cannot control physician productivity. I have worked a position where I was eligible for bonus percentage in certain situations. For example, claim denied, appeal denied, and I was submitting a second appeal. I was eligible to get a bonus on those. However - 1) I was already making an hourly rate I thought was fair 2) after a few months, we decided tracking these appeals was too time consuming and instead received a small salary increase.
If you are needing to work over 40 hours without adequate compensation, get a price to outsource some of these things (like credentialing for example). Explain that you performing these activities is saving the practice $XXX and that is why you are worth a higher salary.
Rates can vary a lot from area to area. Other items like PTO, health insurance, dental insurance, paying for memberships, etc. also impact your total compensation. For some people, other items like your work environment, your hours, remote capability, your coworkers, etc. play a very important role in whether you feel fairly compensated.
Personally, I am not a morning person, and having an employer that gives me flexibility in start time is a huge plus. Feeling personal satisfaction about the work I do is also a big factor. These items may not be important at all to another person. Whatever is personally important to me might be worth a few dollars an hour.
All that said, my personal opinion is that someone working for you 3-4 years should not even have to ask for a raise. Barring some type of financial setback in the practice, there should be some type of periodic increase, even if it's only minimal due to finances. Reviews and feedback should be occurring whether or not they come along with increased compensation.

 

[sinman0531]

If you have that much experience, it’s time to find a new job. Honestly, I’m not even sure if providing you a bonus based on a specific dollar amount is legal. I would imagine even if it is legal, the dollar amount they would choose would be difficult to hit. If it wasn’t, they would just give you the raise.