SNF vs. Home Health Billing: Key Differences and Best Practices

Billing for services in both skilled nursing facilities (SNFs) and home health care involves handling complicated healthcare reimbursement systems while ensuring accurate documentation, timely claim submission, and compliance with billing regulations. Despite their similarities, such as the reliance on Medicare coverage, coding requirements, and the importance of accurate documentation, there are distinct differences between SNF and Home Health billing practices that healthcare providers must understand to optimize their billing processes effectively.

The key to ensuring accurate billing and reimbursement in both SNF and Home Health settings demands the need to understand the main differences between both, which are as follows:

Key Differences SNF vs. Home Health Billing

• Setting of Care

SNF Billing: It includes billing for services provided in an inpatient setting that involves different codes and billing procedures compared to services provided in a patient’s home.

Home Health Billing: It involves billing for services provided in a non-institutional setting. It also requires specific documentation and billing codes customized to home health services, reflecting the unique nature of care provided outside a facility.

• Reimbursement Structure

SNF Billing: Reimbursement is enjoyed under the Medicare Prospective Payment System (PPS) for SNFs. In fact, it is based on a predetermined rate determined by the Resource Utilization Group (RUG) level, which considers factors such as the patient’s clinical condition and care needs during their stay.

Home Health Billing: Reimbursement is available under the Home Health Prospective Payment System (HH PPS). It is based on a predetermined rate determined by patient characteristics and the type of services provided during a 60-day episode of care, reflecting the intermittent nature of home health services.

• Frequency of Visits

SNF Billing: Billing for around-the-clock care in SNFs involves capturing services provided by various healthcare professionals throughout the day. It includes nursing, therapy, and other ancillary services, resulting in a different billing structure than intermittent home visits.

Home Health Billing: Billing for intermittent visits in home health involves documenting and billing for services provided during scheduled visits. It is provided by nurses, therapists, and other healthcare professionals based on the patient’s individualized care plan, reflecting the less continuous nature of care provided in the home setting.

• Coordination of Care

SNF Billing: Billing for services in SNFs involves coordination among various healthcare professionals within the facility, with billing reflecting the multidisciplinary approach to care provided in this setting.

Home Health Billing: Billing for services in home health involves coordination between the home health agency, the patient’s primary care physician, specialists, and other community resources, with billing reflecting the collaborative effort to ensure continuity of care in the home setting.

Though SNF is quite different from Home Health Care, there are common practices that prove to be best for both, such as:

• Accurate Documentation

Accurate and thorough documentation of all services provided is essential for SNF and Home Health billing. This includes detailed records of patient assessments, care plans, progress notes, and discharge summaries. Accurate documentation ensures compliance with Medicare guidelines and facilitates proper coding and billing for services rendered.

• Timely Submission of Claims

Prompt submission of claims is also crucial to ensure timely reimbursement. Delays in claim submission can lead to payment delays and potential cash flow issues for healthcare providers. This means there is a need to establish efficient processes for claim submission, including verifying all required documentation and coding accuracy, which helps expedite the billing cycle.

• Verification of Insurance Coverage

Prior to providing services, verifying patients’ insurance coverage, including Medicare eligibility and any additional insurance plans, is critical for both SNF and Home Health billing. This helps ensure that services are covered and reduces the risk of claim denials due to insurance discrepancies.

• Utilization of Electronic Health Records (EHR)

Utilizing Electronic Health Records (EHR) systems streamlines billing services for  SNF and Home Health Care by centralizing patient information, facilitating accurate documentation, and improving billing efficiency. EHR systems enable real-time eligibility verification and electronic claim submission, reducing paperwork and administrative burden.

• Monitoring and Auditing of Billing Processes

Regularly monitoring and auditing billing processes helps identify and rectify errors or discrepancies in billing practices for SNF and Home Health Care. In fact, conducting internal audits, reviewing claims data, and proactively addressing any identified issues can improve billing accuracy and compliance.

Outsourcing SNF & Home Health Billing

Outsourcing billing services to 24/7 Medical Billing Services can benefit SNF and Home Health providers, particularly for smaller practices or those with limited in-house billing expertise. We can streamline billing processes, reduce administrative burdens, and improve revenue cycle management by leveraging the expertise of medical billing professionals and dedicated resources. It allows healthcare providers to focus on delivering quality patient care while ensuring efficient and accurate billing practices.

See also: Why Data Analytics Is A Game Changer For SNF Billing?