Most skilled nursing facilities (SNF) face a double quandary because first, they have to operate under increasing financial pressure, and second, there is rising anxiety over staffing and infrastructure. Added to the Balanced Budget Act of 1998 changes the way SNF reimbursements are done.
This article will give a comprehensive guide on SNF billing and problems and how to overcome them.
Challenges of Billing with Skilled Nursing Facilities
For successful reimbursements in SNF claims, one needs to know the consolidated billing requirements. But that’s not all. The billing staff needs to have comprehensive knowledge about the codes and the procedures and facilities covered by Medicare A. Anything that is not covered will lead to claim denial. But the complexity continues as there are some benefits which are not covered by Medicare A are covered by Medicare B. The SNF, in such a case, has to identify the difference and bill it separately to get paid.
The payment on a per diem basis, on the other hand, means CMS pays a fixed amount to SNFs under Medicare A. In such a case, the SNFs pay the providers of the contracted nursing services.
To get this payment, the SNF has to follow specific procedures:
- For getting paid, SNF has to claim the consolidated billing for Prospective Payment Systems (PPS)
- Medicare A pays the SNFs on a per diem basis
Other Problems faced by Skilled Nursing Facilities in Billing
Since SNF billing is a complex process, it is exposed to quite a few problems regarding revenue collection. Some of the situations that lead to reimbursement for the services rendered are:
- Applying incorrect codes for the services, which leads to claim rejection
- Staff lacking sufficient knowledge of the services covered by Medicare A and B
- The nursing facility fails to accommodate or understand the cost borne for the per diem or fixed payment. Since there is a range of elasticity in the cost of services that fixed rates offer, services often fail to encompass that, which results in loss of payment
In all the above cases, the SNF exposes itself to revenue leakage. In one scenario, it is by claim rejection whereas in another, it is by getting underpaid for the service. Also, the lack of knowledge in how to bill for services provided by the facility when excessive time is spent with the patient on non-medical activities means a loss of revenue.
However, all these situations and factors can be mitigated with proper revenue cycle management software and trained people who can process all these while having proprietary technology for the facility. With most SNFs being challenged with the staff and overworking, getting the staff trained can be a challenge, so how to ensure SNF can thrive?
How To Make The Skilled Nursing Facility Thrive?
There is a rise in the aging population and the demand for skilled nursing facilities. But many SNFs fail to prosper because of the above challenges and problems. However, the best way to mitigate them is by outsourcing the SNF billing services to a third-party organization such as 24/7 Medical Billing Services.
Over the years, 24/7 Medical Billing Services has helped nursing facilities improve their revenue. The focus of 24/7 Medical Billing Services has been to reduce claim rejections while helping nursing facilities to build better services.
24/7 Medical Billing Services, medical coders and billers have extensive knowledge about the intricacies of SNF billing and coding. As a result, they take the burden on them to ensure the entire medical billing cycle runs appropriately. They start with identifying the edibility of the patient’s reimbursements to separating the Medicate A and Medicare B items, so the billing is done correctly. The team looking after the SNF billing system also conducts regular post-claim submission and follows it up to ensure timely payment for the services done by CMS.
24/7 Medical Billing Services offers a flexible model for the SNF. It allows them to choose the service that fits them. It also offers in-house SNF billers and coders through the 24/7 Medical Billing Services portal to the off-shore location of billers and coders. While the while can dedicate itself to providing nursing care to the patients, the outsourced team will work on the entire coding and billing range to ensure on-time payment.
Also, the RCM model offered by 24/7 Medical Billing Services for any SNF involves an in-depth study of the services revenue cycle management to identify areas that causes loss of revenue. Also whenever needed, we help replace the outdated and legacy-based revenue collection process with the latest software that can be customized as per the particular SNF’s requirement.
It also helps train the staff to understand the new environment and ways to get the best out of the outsourced billing management system. Since SNF, at times, operate differently based on federal and state laws, 24/7 Medical Billing Services has the knowledge to work as per the local and national network to meet the SNF’s billing and coding requirements.