In 2012, educated practice owners want more out of their physical therapy software. In particular, today’s savvy executives demand financial security for their practice.

Systems4PT makes honing in on profitability simple. We lead executive profitability seminars every month clearly explaining how to focus and act on “The Number”. (You can sign up for this free webinar on the ‘Contact Us’ page on this website.)

“The Number” is: What percentage of patient treatments are profitable for your practice?

What’s “The Number” for your practice?

If you don’t know this answer, you will install paperless physical therapy software, integrate departments, eliminate paper… and continue to feel the slow burn of healthcare’s tightening outpatient rehab sector. You deserve much better.

“The Number”. For the average practice, 37% of patients are treated at a loss.

This statement should give you cause to pause. Why do you work so incredibly hard, when over a third of your work is delivered at a loss? Yes you’re being paid for the treatment.. But you’re being paid less than it costs you to treat the patient – You’re losing money. 3 out of 10 patients.

What’s your number?

Some will advise that these low paying treatments cover a portion of variable overhead. But let’s get serious: You deliver 110% clinical excellence. Why would you willingly accept break even or better on only 63% of your patient treatments?

Is your goal to treat as many patients as possible? Or is your goal financial security? Or would you like to accomplish both? You can’t win the game if you don’t know the score. And today, you don’t know “the number”.

With the push of one button, Systems4PT shows you how to achieve in-your-pocket, take-to-the-bank profit, by referring Dr., by marketing campaign, by Payor and/or by therapist. Systems4PT will not only show you “The Number”, our integrated physical therapy software will also show what changes to make to improve it. Other physical therapy practice management systems bury you in reports. But none of them tell you, “the number”.

Look out over your treatment floor. It’s probable that 1 out of 3 patients out there are being treated at a loss.

Let’s fix it!

 This transition will require business and system changes throughout the healthcare industry. Everyone who is covered by the health insurance portability and accountability act (HIPPA) must make the transition, not just those who submit Medicare and/or Medicaid claims.

In addition to transitioning to ICD-10, the CMS has mandated evolving toward to version 5010 of the ANSI X12 standard for claims transactions necessary for ICD-10 adoption. The 5010 standards will replace the existing 4010/4010A1 version of HIPAA transactions, which go back nearly a decade and address many of the shortcomings in the current version, including the fact that 4010 does not support ICD-10 coding.

Background on ICD-10 coding

On October 1st, 2013, ICD-10 – CM diagnosis codes will be used by all providers in every health-care sector.

ICD 10 – PCS procedure codes will be used only for hospital claims for inpatient hospital procedures.

On ICD-9 codes will not be accepted for services provided on or after October 1, 2013. ICD-10 codes will not be accepted for services prior to October 1, 2013.

The differences between ICD-10 codes and ICD-9 codes is primarily in the overall number of codes, the organization and structure, code composition and the level of detail.

There are approximately 70,000 ICD 10– CM codes compared to approximately 14,000 ICD-9 diagnosis codes.

In addition ICD-10 codes are longer and use more alpha characters which enable them to provide greater clinical detail and specificity in describing diagnoses and procedures. Also, terminology and disease classification have been updated to be consistent with current clinical practice.

The Rationale behind making the change from ICD-9 to ICD-10 codes

The ICD-10 coding classification system will provide the necessary data needed to:

• Measure the quality, safety and efficiency of care
• Design payment systems and process claims for reimbursement
• Conduct research, epidemiological studies and clinical trials
• Determine health policy
• Support operational and strategic planning
• Designed healthcare delivery systems
• Monitor resource utilization
• Improve clinical financial and administrative performance
• Prevent and detect healthcare fraud and abuse
• Track public health and attendant risks

Preparing your practice for ICD 10 coding

Systems4PT is now compliant with version 5010 of the ANSI X12 standard for claims transactions. While the official start date for ICD 10 is October 13, 2013, Systems4PT will be conducting actual tests with ICD-10 data beginning January 1, 2012.

The transition from ICD-9 to ICD-10 is unforgiving. ICD-9 coding will no longer be accepted for treatments rendered after October 1, 2013. ICD-10 coding will not be accepted for treatments rendered prior to October 1st, 2013. There is no transition period or grace period.

Systems4PT practices will be well-equipped for this upcoming change as their systems will be updated automatically with instructions will be provided in advance.

In 20 months, coding, the foundation of your practice’s compliance and cash flow will be changing. With ICD-10 the number of possible diagnosis codes increase 500% from today. Confusion, non-compliance and rejected payments will be the norm for a tremendous number of practices.

The answer certainly involves preparation and training. But it also involves technology. Systems4PT’s PayTrend™ automated coding prompts will intuitively guide therapists toward which codes are paid, by diagnosis, by payor – based on actual payor trends in your region. While, by definition, PayTrend™ technology requires at least one cash cycle to identify trends, your therapists will quickly be guided toward compliance and maximum charge capture, even in the strange, new ICD-10 environment.

ICD-10 is as complex, unforgiving and impactful as any issue your practice has faced in decades. It’s vital that you make a clear, honest assessment of your practice’s billing & collection capabilities. If current billing protocols are ‘just getting by’ you need to find help. You can call Clarissa at Systems4PT (814-494-1070). She will schedule a free webinar that will show how your practice can transition to ICD-10.

What are you going to do when your billing manager leaves?

84% of practices have one billing employee. One expert. One brain trust.

All this is worth thinking about. In our experience, when the billing expert leaves the practice:

• Monthly collections decline precipitously.
• Accounts receivable steadily increase.
• Treatment rates decline. These factors distract the practice owner.
• Emphasis on marketing is postponed. Treatment rates decline further.
• The practice owner finds her/himself increasingly “sucked into a black hole of confusion” surrounding fewer patient treatments, each of which are consistently paid less than before.
• People start using phrases like “covering payroll”
• It takes time to train a new billing manager, and many times that new person leaves in frustration. Then the entire process starts all over again –the practice owner recruits another billing manager, etc., etc.

Reimbursement rates simply don’t allow most practices to carry excess billing personnel, and those rates are declining. Finding a competent billing manager is difficult, and the good ones are increasingly more expensive. And you know what? It is probable that this scenario will happen in your practice.

It isn’t a question of if. It is a question of when.

When thinking about your cash, billing and collections continuity definitely deserves your attention and must be planned for in advance.

Shared frustration.

Like outpatient rehabilitation, each sector in healthcare is growing. Each sector is being squeezed with rising costs and declining reimbursement rates. Providers are in short supply. Practice owners are “capacity constrained”, and the increasing complexity of payor rules is making truly effective collection specialists harder to find and more expensive to hire.

Can you out-bid your local orthopedic surgeons or hospital for billing talent?

Add to this conundrum that a meaningful percentage of newly hired billing managers don’t make the grade. Outpatient rehab billing is the most complicated segment in the entire medical arena, and a biller from a dentist is in for a steep learning curve. Moreover, experience on one automated computer system doesn’t mean success on a different system. And many billing professionals “getting back into the field” after taking a few years off are finding that “the field” has changed. It’s a whole new world.

The growing trend in healthcare addresses this inevitable business crisis. The shear complexity of each medical sector, combined with the finely tuned precision required by state-of-the-art-billing systems, juxtaposed with a dynamic environment of shifting payor rules has led to a new paradigm in collections management: Outsourcing to competent experts.

In every sector of healthcare — MDs, surgeons, dentists and outpatient rehabilitation — a new breed of laser-focused companies is doing one thing and doing it very well: Collecting Cash!

For many practice owners, “outsourced billing” are bad words for good reason. Unsophisticated outsource billers with a “bill it three times and write it off” approach have been ripping clinics off for years. If someone offered to outsource your billing, you were smart to run away. But today there is a sophisticated new approach. Billing has been automated. Now, the state-of-the-art is outsourcing collections.

In every case, this new breed of collection specialists leverages technology. They provide the practice owner with powerful software that is specific to their medical sector. This software integrates with collection specialists. These companies invest heavily in training software as well as collection protocols at levels that the private practice simply cannot afford and if one collection specialist leaves, another is right there, equally expert on your specific collection challenges.

Systems4PT has raised the bar on this leading-edge strategy. The largest division of Systems4PT™ is Integrated Focus Collection Services™. The majority of our new customers are “Focus Customers”, for whom we manage billing and collections.

Our innovations are aimed at maximizing:

• Efficiency
• Compliance
• Charge Capture

Whether it’s automated PayTrend™ coding prompts, Medicare Cap tracking (in dollars), payor specific minute/unit tracking, automated modifiers or our other state-of-the-art features, Systems4PT™ software delivers clean claims with maximized charge capture. Innovation is the cornerstone of Integrated Focus Collections Services™ and Focus members receive all upgrades at no charge, which allows our Account Managers to spend their time on the real job – collecting cash. They spend 60% of their time working aged receivables (vs. less than 10% with the normal “billing company”), and when this happens, clinics collect more cash…faster.

Moreover, the exponential benefit of this technology-driven approach is your focus. In all sectors of healthcare, practice owners are finding that partnering with competent, technology- driven collection specialists provides continuity and stability, which in turn allows them to focus on what matters: Clinical excellence, compliance and marketing the practice.

‘Beats the heck out of worrying about payroll!’

Continuity = peace of mind is where you need to be `when thinking about your cash. And remember, it is not a question of if, but when this scenario will occur. So when you’re faced with a transition in billing staff, avoid the typical pitfalls.

Get focused on your practice, and let us focus on your cash!