Are you running a Skilled Nursing Facility (SNF)?

If yes, you must keep in mind that operating an SNF involves much more than providing just quality care. SNFs would mean offering 24/7 nursing services, rehab therapies, medication management, and assistance to patients with complicated needs. Due to the nature and delicacy of patient care required, accurate SNF billing and coding are not only necessary to prevent claim denials but also to stay compliant with regulatory requirements.

In contrast to general medical billing, Skilled Nursing Facility billing involves specialized care, accurate documentation, and proper application of codes and modifiers for maximum reimbursement. In fact, one coding or documentation mistake has the potential to result in lower revenue or postponed payments, which can affect the health of the facility’s finances.

This blog will explore the common hidden challenges skilled nursing facilities have in their billing process and the best strategy to deal with them.

Hidden Skilled Nursing Facilities’ Billing Challenges

SNF billing faces many underlying challenges that can affect the facility’s operations and revenue. Knowing these challenges is the most initial step toward effectively managing them to achieve an easy billing process. These challenges are:

Challenge #1: Failure to Keep Up-to-Date Patient Information

One of the most prevalent yet overlooked challenges is keeping and maintaining up-to-date and accurate patient insurance information. When insurance information, patient eligibility, or authorizations are not up-to-date, claims are often denied, causing payment delays. Patient insurance coverage verification on a routine basis before each visit is also required. Failing to do so puts the healthcare provider at risk of excess days in accounts receivable (A/R), which damages cash flow and overall financial health.

Challenge #2: Inexperienced Billing Team

It should be remembered that having an offshore medical billing and coding team that is well-versed in SNF billing is essential. An undertrained team may struggle with billing software, coding rules, and communication, resulting in claim errors and delayed healthcare reimbursement. SNF billing demands knowledge of Medicare, Medicaid, and insurance details. When the team is not well-trained, revenue cycles lag behind, and the facility may miss out on payments it rightfully deserves. In order to overcome this, numerous SNFs are opting for outsourcing medical billing and coding service providers in India.

Challenge #3: Uncertainty About Patient Residency Status

Billing can be complicated if the residency status of the patient in the SNF is not clearly determined. In fact, Medicare and other payers require confirmation of residency to determine coverage eligibility. If a patient receives treatment but is not a resident, claims could be denied or delayed. This implies that billing personnel should confirm residency status during patient visits to prevent unnecessary improper claims and loss of revenue.

Challenge #4: Maintaining an Accurate List of Drugs and Services

SNFs are required to keep a comprehensive and updated list of all drugs and services that are subject to consolidated billing rules. This includes understanding what drugs and services are covered by Medicare and which are not covered. Consequently, failing to keep such a list can result in improper billing and denied claims. Keeping this information accurate ensures that the facility has billed appropriately and adhered to Medicare guidelines.

Challenge #5: Lack of Claim Tracking and Follow-Up

A large portion of claims are denied, and most of these denied claims are never resubmitted, resulting in lost revenue. Accurate tracking of claims, examination of denial reasons, and resubmission of corrected claims is time-consuming but important. Facilities that neglect claim follow-up risk leaving substantial revenue on the table. Thus, it is important to implement a mechanism for ongoing claim monitoring that enhances recovery rates and overall financial performance.

Challenge #6: Improper Coding and Documentation

Proper coding and complete documentation must be done in order to submit clean claims. But physicians may not have sufficient time to complete documentation, and challenges with electronic health records (EHR) can cause errors or omissions. Incomplete or incorrect coding typically leads to claim denials. To better deal with this, SNFs should invest in training staff and re-designing workflows to incorporate documentation and coding into regular routines more effectively.

Challenge #7: Inefficient Accounts Receivable Management

Accounts receivable management is usually an unnoticed challenge with significant potential to disrupt cash flow. When A/R is greater than 50 days, it means extended payment days and lost revenue. Most SNFs have overwhelmed billing staff, and it becomes challenging to meet collections. Automating A/R processes or outsourcing the billing can free in-house personnel time, enhance collection effectiveness, and assist in maintaining a stable revenue stream.

One Stop Solution: Outsourcing to ICS

One of the most effective ways to overcome the common billing challenges skilled nursing facilities face is by outsourcing offshore medical billing and coding services to India. In fact, you can have all SNF billing aspects handled professionally and correctly by a reliable company such as Info Hub Consultancy Services. Their professionals are adequately trained in the latest regulations on billing and use advanced software that integrates smoothly with other payment systems.

Medical providers can increase cash flow by as much as 20% and decrease billing mistakes by almost 80% by outsourcing to ICS. Not only does this save time, but it also allows for efficient and reliable revenue cycle management. Call ICS today to see how their skilled nursing billing services can benefit your facility’s bottom line.

FAQs

1. What is PDPM, and how will it impact SNF billing?

The Patient-Driven Payment Model (PDPM) alters Medicare SNF reimbursement from patient-need-driven to patient-need-based instead of therapy minutes.

2. How frequently should SNFs check patient insurance eligibility?

Insurance eligibility should be verified before admission and regularly throughout the patient’s stay.

3. Are SNFs responsible for billing non-covered services?

SNFs must clearly separate and bill non-covered services directly to the patient or other payers.

4. How does Medicare Part A vs Part B affect SNF billing?

Part A covers inpatient SNF stays under specific rules, while Part B covers outpatient or non-residential services.

5. Can SNFs bill for telehealth services?

SNFs can bill for eligible telehealth services under certain conditions and payer policies.

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