wRVU Outlier Productivity Review
Ensure high productivity is supported by compliant, defensible practices.
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When a provider exceeds the MGMA 90th percentile in work RVUs (wRVUs), leadership should take a closer look to confirm the production reflects accurate documentation, appropriate coding, operational feasibility, and alignment with compensation strategy.
We conduct structured, multi-phase evaluations that assess documentation integrity, coding accuracy, operational practicality, and medical necessity. Our reviews help strengthen compliance oversight, support defensible compensation arrangements, and reduce organizational risk.
The Risk Behind wRVU Outliers
Outlier productivity often warrants thoughtful review.
Without structured evaluation, organizations may face:
- Compensation compliance concerns
- Increased audit scrutiny
- Payor reimbursement challenges
- Regulatory exposure
- Fair market value (FMV) alignment questions
- Litigation risk
These risks frequently intersect with broader provider compensation planning, valuation analysis, and regulatory alignment efforts.
Our Structured Evaluation Approach
We tailor each engagement based on the provider’s profile and your organization’s specific concerns. Together, we determine which phases are most appropriate.
Our process is methodical, objective, and designed to provide clarity for leadership.
Phase One: Documentation & Coding Audit
We evaluate whether documentation and coding appropriately support reported production levels.
This review includes:
- Documentation compliance with current guidelines
- Modifier usage analysis
- Time-based billing review
- Split/shared services evaluation
- Teaching physician requirements assessment
- Bell curve comparison of coding patterns to peer benchmarks
We review a minimum of 30 encounters per provider, typically using randomly selected governmental claims. This phase often complements broader Coding, Documentation & Revenue Integrity initiatives.
Phase Two: Operational Reasonableness Review
High production should align with realistic scheduling and clinical capacity.
We assess:
- Daily schedules and time allocation
- Estimated visit duration based on billed codes
- Administrative, teaching, and procedural responsibilities
- Hospital coverage and medical directorship obligations
We compare encounter volume and coding levels with available time to determine whether reported productivity is operationally achievable. Findings from this phase may inform Physician Enterprise Alignment & Workforce Planning strategies, particularly when productivity and scheduling models require refinement.
Phase Three: Clinical Documentation Medical Necessity Review (CDMNR)
When questions arise regarding clinical appropriateness, board-certified physicians practicing in the same specialty conduct a peer review.
This phase evaluates:
- Medical necessity of services
- Appropriateness of procedure selection
- Alignment with specialty society guidelines
- Evidence-based standards of care
We typically focus on high-volume or high-risk procedures with significant revenue or audit implications.
Specialties frequently reviewed include:
- Orthopedics (Joint Replacement, Spine)
- Cardiology (EP, Structural, Interventional)
- CT Surgery
- Neurology
- Interventional Radiology
- Pain Management
- Vascular Surgery
- Urology
- General Surgery
- Gastroenterology
- GYN Surgery
- Wound Care
CDMNR frequently supports organizations undergoing heightened compliance review, compensation restructuring, or transaction-related diligence.
What Leadership Should Be Assessing Now
- Are productivity outliers monitored consistently?
- Is compensation aligned with defensible production levels?
- Can documentation withstand external review?
- Are high-revenue procedures supported by clear medical necessity?
- Does governance have visibility into productivity trends?
Structured review strengthens oversight and promotes long-term sustainability. In many organizations, productivity review becomes part of a broader compensation governance or alignment strategy.
How This Supports Your Organization
Our review provides:
- Independent, objective evaluation
- Certified coding expertise
- Specialty-specific physician peer review
- Clear findings with practical recommendations
- Reporting that supports leadership and board discussions
We help you gain confidence in the integrity of your productivity and compensation structures. Whether used proactively or in response to audit concerns, this service strengthens your broader compliance and compensation oversight framework.
Ensure Appropriate Oversight of High Productivity Providers
If your organization has providers exceeding benchmark productivity thresholds, we can help you determine whether additional review is warranted.
We can help you determine:
- Whether current productivity is defensible
- Whether compensation alignment requires review
- Whether documentation or clinical patterns warrant deeper analysis
- How findings should be presented to executive or board leadership
Schedule a confidential discussion to review your organization’s approach.
Experts, focused on your needs.
Why Trust Coker
For more than three decades, Coker has been a trusted partner to healthcare leaders and investors, delivering clarity, compliance, and confidence through every stage of the transaction and beyond.
Positive outcomes are possible for you and your patients.
We approach every engagement with a results-driven mindset, leveraging our deep industry expertise and data-driven insights to develop strategies that drive meaningful, measurable improvements in performance.
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