Skilled Nursing Facility (SNF) differs from nursing homes, so their services are also different. Many confuse the two, but nursing homes can have experienced nurses who do not require professional care like SNFs, which marks the difference between the two. In most cases, the care provided by SNF is by occupational therapists, physical therapists, speech-language pathologists, and common and licensed practical nurses. Though the list is not exclusive, patients in SNFs that are part of the Medicare practice can be admitted to skilled nursing residents in several cases. Thereby, the billing process resulted in problems that were eventually rectified with the SNF consolidated billing (CB).
SNFs Billing Issues
The confusion between nursing homes and SNF often results in claim rejection and denials. In the Balanced Budget Act of 1997, Congress mandated that most nursing services be provided under the SNF in the potential payment bundle. The bundle was to be paid through Part A of MAC (Medicare Administrative Contractor).
Hence, the SNF can furnish services covered in Part A in the consolidated billing (CB). In fact, it can be done by using the resources of the SNF directly, transfer agreement with the SNF, or with a particular therapist as agreed by the SNF.
SNF can also unbundle a service, thus allowing them to permit providing services directly to the patient by an outsider supplier. The outsider then can submit the claim to Medicare Part B, where SNF doesn’t need to be involved. This method of claim submission, however, caused specific issues:
• There could be duplication of bills when both SNF and the supplier billed for the same services
• Beneficiaries often incurred the out-out-pocket liability for the deductible of Part B despite the supplier billing the insurer for that.
• The residents’ quality of care was adversely affected when different outside care suppliers were brought into the program.
Requirements for Consolidated Billing For SNF
The Balanced Budget Act of 1997 (BBA), Public Law 105-33, Section 4432(b), was enacted by Congress, and it required the SNF to undertake Consolidated Billing (CB). Under this enactment, the SNF had to submit the claims provided to the residents to Medicare. The only services that could be exempted were the ones that were not listed.
CB ensures no duplication of the billing while meeting the responsibilities it has towards the patients. But there are certain exceptions, which are excluded from the CB. Hence the billing can be done separately.
Taking Care Of The Requirements of SNF Consolidated Billing
The CB makes the SNF coding and billing process quite complex. It requires the SNF staff to adhere to these new billing guidelines while keeping track of hundreds of accounts of residents, their bills, and the insurance companies’ documents. The need to find ways to integrate and configure these data and streamline the billing and management process is essential. Since the CB aims at providing better management and revenue to the SNF, the facilities must adhere to the rules and regulations. It can be quickly done to save money and time while the financial data is managed accurately for the SNF consolidated billing.
However, many facilities and their admin staff find managing the SNF consolidated billing process challenging. It often leads to revenue loss and, worst case scenario, getting investigated by the authorities and fined for wrong billing and coding. All these problems can be quickly resolved with the help of an expert partner like 24/7 Medical Billing Services.
Why Outsource SNF Billing and Coding?
The experts of 24/7 Medical Billing Services in SNF consolidated billing are equipped with the latest guidelines and knowledge of the CB in Skilled Nursing Facilities. They also have the necessary EHR software to manage SNF consolidated billing. The EHR software can process high-volume data, including coverage of the residents and the payer plans.
Apart from such software, the trained staff understands the importance of proper coding, which is required in CB for skilled nursing facilities. Hence by working with the experts, any SNF can get the best-streamlined billing and coding process. It eventually ensures every bill is claimed on time, no delays in A/R, and no claim denials, rejections, and issues with reimbursement of the services. In the long run, the admin can put in place a better revenue management cycle for the SNF by adhering to the CB guidelines and warranting a better ROI for the facility.