Skilled Nursing Facilities (SNF) must ensure they get timely payment, for which they need to follow an efficient revenue cycle management practice. The practice needs to look after proper submissions that are denial free for effective account receivable management. The SNF must conduct efficient payer-follow-ups, stay compliant with the healthcare regulations, and do other admin works to warrant their survival in the business. With the increase in the growth of SNFs, which are now being funded by Medicare, Medicaid, and private insurance companies, the facility must be able to stay up with the reforms. In the SNFs, there is quite a significant increase in the regulatory restrictions. In this, the consolidated medical billing and coding has become a patent system in covering the services within the scope of SNF care. Hence the medical biller must have a sound understanding of the inclusions and the exclusions in the consolidated billing to ensure timely reimbursement.
Unless the facility takes care of all these aspects in their billings, along with some other SNF billing challenges, it would be difficult for SNF to survive.
Challenges Faced By SNF Billing
For having a successful claim in the skilled nursing billing and coding, the knowledge of codes for the consolidated billing is required. Also, familiarity with the items covered and not covered by Medicare A is essential. If a procedure is covered by Medicare B and not Medicare A, then the SNF biller has to identify it in a separate bill.
Some of the common challenges SNF Billing faces that wreak havoc on the revenue are the following. Once these challenges are managed and mitigated, the facility will enjoy running smoothly.
Challenge 1: Failure to Keep Patient Information Up-to-Date
A clean claim is possible for any SNF only when the patient information is up-to-date. If you do not regularly verify the patient’s insurance information, your facility risks increasing the days in A/R because of denials based on eligibility. It is a must for your practice to ensure there is a proper verification of the insurance coverage, authorization, and eligibility before the check-ins.
Challenge 2: Inexperienced Team
The medical billing specialists should not be a group of people whom you just gather as an afterthought for your practice. The medical biller must be experienced in skilled nursing billing and help increase revenue. If the biller has any problem working with the practice management system or communication, then the facility’s revenue cycle will suffer.
Challenge 3: SNF Residency of the Patient
When it comes to treating a patient in SNF, it is a bit trickier than treating them in a hospital. To ensure that you get your claims from Medicare, Medicaid, or any other insurance company when treating a patient in SNF, you have to determine the patient’s status. It is vital to know during the appointment whether the patient is a resident of the SNF or not. If the patient is not a resident, the billing procedure can be challenging.
Challenge 4: List of Drugs
Any SNF servicers need to maintain an updated list of services and drugs that can administer to the patients. The list should be comprehensive to mention the excluded services and drugs in the consolidated billing.
Challenge 5: Improper Coding & Documentation
Accurate coding and documentation are a must for creating clean claims. EHR difficulties and the limited time the providers have during the office visit can result in the burning out of the physicians. As a result, the relevant codes and supporting documentation can be missed. A workflow redesigning and training can assess and adjust the process that will fit into the everyday work of the SNF.
Challenge 6: Not Tracking the Claims
An estimated five percent of claims get denied, and about fifty percent of the denied claims are not resubmitted. The figures are indicative of the fact that revenue an SNF incurs due to not tracking the claims. It is essential to keep track of the claims and denials and resubmit them as clean claims. The process is time-consuming and complex, but staying on top of the game will ensure you do not lose out on revenue. Also, understanding the reasons for the claim denials can help mitigate the error in the future.
Challenge 7: Account Receivable Management
Any SNF that struggles to collect the account receivables (A/R) will result in the revenue cycle. As a rule of thumb, the A/R should not be more than 50 days. The practice’s billing department does have to focus on managing the A/R. Since most SNFs have overworked medical billing staff, outsourcing the skilled nursing billing practice is a good execution plan. Also, automating the process can help free up time for the billing staff.
How to Mitigate These Challenges?
One of the best ways to mitigate these seven common challenges SNF Billing faces is by outsourcing the SNF billing and coding. An outsourced SNF billing company like 24/7 Medical Billing Services has the knowledge to take care of all the billing and coding challenges an SNF faces. They also have the latest software that works with other payments.
Did you know outsourcing skilled nursing billing services helps the provider to increase their cash flow by 17 percent while reducing by 80 percent the billing errors?
Contact us today to know more about how 24/7 Medical Billing Services can help your SNF with skilled nursing billing and coding and revenue cycle management.