Physician Compensation in the Books: RVUs, Collections, Quality Bonuses

How to Track and Reconcile Compensation Models Without Financial Blind Spots

Physician compensation models have grown more complex over the last decade—especially with the shift toward value-based care. Whether you're paying by collections, RVUs (Relative Value Units), quality incentives, or a hybrid, the key challenge for most practices is turning that model into accurate, auditable books.

At ACCORDPRO, we help healthcare organizations align financial reporting with real-world compensation models. Here's how to properly structure, track, and reconcile physician pay—while staying compliant and financially transparent.

Common Compensation Models Explained

1. Collections-Based Physicians are paid a percentage of the revenue they generate (net or gross collections).

Pros: Easy to track in smaller practicesCons: Payment delays due to claim lags, potential disincentives for collaborative care

2. RVU-Based (Productivity) Compensation is tied to RVUs assigned to each CPT code, regardless of payer reimbursement.

Pros: More equitable across payer types; aligns with academic and hospital systemsCons: Requires accurate RVU tracking and coding consistency

3. Quality-Based Bonuses (Value-Based) Physicians earn bonuses based on metrics like patient outcomes, satisfaction scores, or care compliance.

Pros: Supports quality care and payer alignmentCons: Data-heavy; metrics may lag or be hard to quantify fairly

4. Hybrid Models Most growing practices use a mix—base salary + productivity + quality incentives.

Financial Challenges Behind the Scenes

Even when a compensation model is clear, many clinics struggle with the back-office accounting, including:

• Lag between production and collections

• Errors in RVU or CPT coding reconciliation

• Missing documentation for quality bonus eligibility

• Difficulty aligning financial reports with contracts

• Manual spreadsheets that don’t match payroll books

Best Practices for Tracking and Reconciling Compensation

1. Build a Compensation Tracking System by Provider Your accounting system should include separate class or department codes for each physician to track productivity, revenue, and bonuses.

What to Do:

• Use cloud accounting tools like QuickBooks Online Advanced or Sage Intacct

• Track income and expenses per provider or location

• Set up reporting tags for RVUs, bonuses, and advances

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2. Integrate RVU Reporting With Your Billing System Accurate RVU tracking starts at the coding level. Your practice management system should assign and report RVUs for every CPT code billed.

What to Do:

• Regularly validate RVU reports against billed claims

• Use built-in RVU calculators or partner with coders who understand RVU valuation tables

• Reconcile RVU data monthly to avoid year-end surprises

3. Create Transparent Bonus Calculations If you offer quality or performance bonuses, define the criteria clearly—then track progress throughout the year.

What to Do:

• Align bonus metrics with payers' value-based incentive programs

• Use scorecards or dashboards to update physicians regularly

• Record bonus accruals monthly in your bookkeeping system

4. Reconcile Compensation With Payroll and Books Once physician payments are issued, they must be correctly recorded in your books as compensation—not just as raw draws or advances.

What to Do:

• Maintain a physician compensation ledger

• Record base pay, draws, bonuses, and withholdings in separate accounts

• Run quarterly audits to ensure pay aligns with contracts

5. Work With a Bookkeeper Who Understands Healthcare The nuances of physician compensation don't fit neatly into generic bookkeeping templates. Medical and dental groups need industry-specific systems and expertise.

What to Do:ACCORDPRO specializes in physician bookkeeping, compensation tracking, and payer-aligned revenue mapping. We work with practice owners, administrators, and accountants to keep compensation fair, timely, and audit-ready.

Final Thoughts

Your physician compensation model isn’t just a payroll line—it’s a strategic driver of performance, culture, and profitability. With accurate tracking and structured reconciliation, your books will match your contracts—and your providers will trust your numbers.

Need help building a compensation tracking system that works?

 📞 Contact ACCORDPRO at 425-215-0517 or visit www.accordpros.com to schedule a free strategy consultation.