2019 Reimbursement Trends

With 2019 in the books, Systems 4PT has updated our 8-year, nationwide average collections per claim results for outpatient rehab.

Why did 2012 through 2016 collections per claim increase?

How can actual, nationwide 2016 through 2019 collections per claim be stable?

How We Did It

Payer fee schedules have been steadily declining. But while that was happening, Systems 4PT developed dozens of proprietary collection technologies that increased reimbursements by 1.4% here, 0.2% there, and 0.6% elsewhere. The above graph shows the impact of these new technologies, which began in 2012.

Industry reimbursements have declined by 7–10%, but

Dozens of Systems 4PT improvements, which collect .5% more each, have offset those reductions

Here are 7 Examples:

HardStop™ technology monitors over 50 payer rules in real time and blocks the front desk or therapist if the claim doesn’t pass those rules
Non-compliant claims are not billed out, they are quarantined in a high-profile “Treatments Not Billable” list
The PET (Patient Eligibility Tool) verifies the accuracy of patient demographics and coverage
The patient’s appointment on the schedule “turns green” when all rules have been satisfied. Front Desk Staff always know if each date of service is compliant
The tools listed above deliver an average 99.87% first-pass acceptance rate. Systems 4PT submits the cleanest claims in the industry
Artificial intelligence establishes “payment norms” for every payer by analyzing every claim for every patient in your region, every day. If any claim deviates from your region’s payment norm, the computer feeds that claim to the collector. The computer tells the human which claims to work, and in what order. This intelligence is cognizant of timely filing, claim size, electronic vs. snail mail, necessity for attachments, appeals, and much more
A tremendous amount of credit goes to our practices. Patient obligations such as co-insurance and deductibles are collected today at a higher rate than ever. It’s inspiring to see how Systems 4PT practices have improved at collecting these balances on intake. With Systems 4PT, the front desk is visually cued if the patient has not been checked in and paid their share. This is in total contrast to our industry’s big web-based PT EMR that doesn’t communicate anything for deductible and coinsurance balances due on intake

The reason your reimbursements are falling is that

your EMR doesn’t provide the technologies listed above.

Your payers’ changes are outpacing your EMR.

Systems 4PT Provides:

An average 9.6% increase in collections vs. the practice’s prior approach to billing
With an average 18-day collection cycle (this stat includes workers comp and motor vehicle)
Delivered with our Stress-Free Installation™