Billing, Collections and Declining Reimbursements
A recent industry survey identified that the 2nd greatest frustration for practice owners is maintaining control of payer authorization and billing clean claims that get paid on first submission.
This is not something that “better management” can fix. The solution requires better technology.
Let’s start with the good news:
We solved the problem 4 years ago
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While the survey respondents complained about declining reimbursements, Systems 4PT practices have seen average reimbursements per claim increase, each year, for the past four years in a row.
Most of the survey responses came from the EMR’s member/customers
S4PT practices average $90.89 per claim, nationwide in 2017
The Reasons You’re Not Being Paid What you Deserve
1.Your EMR allows you to bill dirty claims
- Your low reimbursements are proof that your EMR’s claim scrubbing is completely inadequate. It lacks the necessary payer rules.
- Required data is missing, ex. An authorization number
- Other data conflicts with what the payer is expecting, ex. The patient’s name is entered as “Bob”, but the payer is expecting, “Robert”
2.Your EMR is not integrated with your billing system
- Deductibles and coinsurance due, do not transfer to the front desk. This costs you 5% of revenue (the front desk can’t collect them)
- CPT codes often fail to transfer from the EMR system to the separate billing system. These codes are not submitted, you’re not paid
- The EMR calls this, “HL-7 transmission errors”. We call this, “Billing that isn’t integrated”
- There are no scans or PHI in the non-integrated billing system – The biller is blind
3.As a result, your biller spends most of their time on defense, finding, correcting and rebilling rejection
- There aren’t enough hours in the day to get the work done
- While your biller is busy, reacting to dirty claims, payers continue to change their rules and requirements, ensuring future rejections
- Payers are aggressively investing in technology, your biller is simply out-gunned
‘Want Confirmation of the Above? Show This Page to Your Biller . . . . (and watch their reaction)
Here’s How We’ve Increased Collections Per Claim for the Past 4 Years in a Row
Payer Rules are Integrated
Systems 4PT delivers the most robust, real-time claim scrubbing in outpatient rehab
Both therapists and front desk staff are guided toward creating clean claims that satisfy payer rules
As payers change their rules, we update the software
Example, the registration to the right can’t be signed until all requirements have been satisfied
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Visual Confirmation
When every payer rule has been satisfied, the patient turns green on the schedule screen.
Green Patients Get Paid
With Systems 4PT, the front desk’s job is to “Turn every patient green”
And when that happens, you’re paid for every visit
The Conclusion:
- Slow documentation and declining reimbursements are critical problems
- Your EMR has fallen behind and is now holding your practice back
- Your EMR has become a liability
Systems 4PT has solved these problems. Prove it to yourself with a hands-on trial.
Your collections will increase 9% and you’ll pay 1/3 less vs. what your outdated EMR and billing cost today.
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