Skilled nursing homes provide long-term care through support with everyday activities, rehabilitation, and medication and treatment administration. Families of elders considering placing their loved ones in skilled nursing or assisted living must first grasp nursing home billing and coding guidelines in order to determine what type of care they will require and who will pay for it. Some of the secrets of SNF billing and coding guidelines are as follows:
Nursing homes are billed on a monthly basis. Skilled nursing facilities should use Form CMS-1450 when paying for Medicaid Part A. These monthly claims must be submitted on time following a resident’s:
- Drop from skilled care in an SNF
- Exhaustion of their benefit period
When a patient’s or resident’s benefits are exhausted, the claims processing system must appropriately monitor the benefit duration in accordance with CMS rules. The skilled nursing facility billing cycle and the time range for all billing services delivered to the resident should be as detailed as possible. If a resident’s stay began after the month’s first, they would usually be charged per day for room and board multiplied by the number of days since the patient’s admission.
Level of Care Provided
Long-term care facilities give varying levels of care to their residents. Independent living facilities do not provide the same degree of CARE as assisted living facilities. In the meanwhile, an assisted living facility will not offer the same degree of care as a memory care centre.
Facilities charge based on the services and amount of care given. The amount of care offered in a facility can have an impact on how much money it receives. This is because a facility with a high volume of weighted DRGs can receive higher reimbursements. To calculate the payment for a particular case, a unique formula is employed, which involves multiplying the payment rate per case of a specific facility by the assigned DRG’s weight.
Type of Insurance Accepted
If a senior qualifies for Medicare Part A, Medicare will cover the entire cost of their stay in a skilled nursing facility (SNF) for up to 20 days. From day 21 to day 100, a variable daily coinsurance rate takes effect, with Medicare continuing to cover a portion of the stay. Staff should continue to submit monthly claims for non-covered services delivered to the resident after the benefits period has expired. This ensures that the claims system can track the benefit period appropriately. Medicare Part A covers the following services:
- Temporary inpatient care, whether it be in a hospital setting or a skilled nursing facility.
- Hospice care services
- Home health care services
From day 101 onwards, the resident is responsible for the entire expense of care. Meanwhile, long-term care facilities are frequently reimbursed for therapy treatments provided through Medicare Part B, which becomes effective on day 21. Examples of Medicare Part B services include:
- Ambulance services
- Clinical research
- Mental health (Inpatient, Outpatient, Partial hospitalization)
- Durable medical equipment (DME)
- Limited outpatient prescription drugs
Medicare Part B is very important for long-term care SNF facilities since it covers occupational therapy, physical therapy, and speech-language pathology.
Leave of Absence
If a resident decides to leave a nursing home temporarily, they or a family member can sign a bed hold waiver to reserve their room until they return. It should be noted that skilled nursing facility billing will continue even if the resident is not there, albeit the charges may be lower than if the resident was present.
To avoid penalties, skilled nursing facility administrators and accounting personnel must ensure that their SNF billing procedure is accurate. The HHS provides billing advice for long-term care SNFs, including the following items to keep in mind:
- The dates of discharge, death, or the start of a Leave of Absence (LOA) for a patient or resident are not counted as utilization days.
- Medicare does not consider a discharge if a Medicare beneficiary is discharged and returns before midnight the same day.
- The HIPPS rate number appearing on a claim must correspond to the assessment sent to and accepted by the state where the long-term care facility is located.
Outsourcing – Old but All-Time Best Solution!
Maximizing and improving the skilled nursing facility billing process will help nursing homes earn more money. When nursing facilities administrators understand their SNF billing guidelines and implement them accurately, they ensure their facilities can maximize reimbursements for the services they provide.
This process can be complicated and time-consuming, necessitating knowledge of SNF billing rules and regulations, insurance policies, and payment procedures. These issues can be alleviated by outsourcing SNF billing services to 24/7 Medical Billing Services. It also allows nursing facilities to stay in compliance with constantly changing standards, freeing up staff to focus on patient care. Skilled nursing facilities should seriously consider outsourcing as a feasible alternative for enhancing their billing processes and overall financial health.