The continuous transformation of the healthcare industry is significantly impacting skilled nursing facilities across the country. Considering the financial and functional stability, billing is one of the most critical aspects of your facility.
Given the complexities of coding regulations and claim submission guidelines of various payers including Medicare and Medicaid, efficient billing is essential for the financial well-being of your practice.
Billing makes up a core aspect of skilled nursing facilities operations because it determines the facility’s revenue generation capability and cash flow.
skilled nursing facilities need to ensure that they achieve the proper and timely billing system to prevent issues like- claim denials, delayed payment, low income and therefore a poor financial position to invest in quality patient care.
The SNF Billing Crisis
For successful reimbursements in skilled nursing facilities , you must be aware of consolidated billing guidelines.
But that’s not all!
Your staff must be well-versed in the guidelines and claim submission requirements for Medicare Part A, Medicare Part B, and various private insurance companies.
It is evident that anything not covered will lead to claim denial. However, the complexity increases even more as there are some benefits which are not covered by Medicare Part A, but Medicare Part B covers them.
In such cases, your staff must identify the differences between the services to separately bill them.
At the same time, the skilled nursing facilities billing demands an extensive coding and documentation process. The changes within claim submission guidelines of different payers and coding regulations make it more difficult for the providers to maintain a streamlined billing process.
On top of this, the paradigm shifts of care models to value-based care has increased the complexities within the billing and coding process.
In all the above cases, the skilled nursing facilities is left open to the risk of revenue leakage. In one case it is by claim rejection and in another case, it is by inaccurate reimbursement of the service offered. Furthermore, lack of knowledge on how to bill different services offered by the facility leads to claim denials and revenue loss.
Nevertheless, all these scenarios and factors can be prevented by having the right RCM system together with the right people who are able to work through all those complications. Since most skilled nursing facilities experience the staff are overworking, training the staff can be a problem. So, how can your skilled nursing facilities thrive?
How to Make Skilled Nursing Facility Billing Efficient?
There is a rise in aging population and skilled nursing facilities are in demand. However, even with the increased patient volume, many facilities fail to prosper due to the complex maze of skilled nursing facilities billing and coding processes.
To help you enhance your billing processes, here are some tips:
- Bill and code all the services you provide and all the work that you do which includes assessment, progress notes and treatment plans and do this in compliance with regulatory compliance.
- Perform periodic reviews of billing documents to check for lapses in coding, documentation as well as any act of revenue loss.
- Conduct continuing professional development for employees that are involved in billing to understand the regulation and coding well enough.
Optimize Billing Practices with Outsourcing
Hiring a third-party billing service continues to be a go-to strategy for many skilled nursing facilities that need better business results. Proper billing procedures can actually have a positive correlation to a facility’s revenues since claims can be submitted properly and money requited on time.
When administrators have knowledge of the various policies surrounding billing for skilled nursing facilities and apply it correctly they not only facilitate the situation, but they also prevent increased costs in terms of chargeable errors and denials.
Skilled nursing facilities must seek the service of qualified billing service providers to effectively manage some of the challenges that affect billing that include the claim denials, underpayments, and documentation.
Also, outsourcing allows for the decrease of the administrative burden, so inside the facility, the focus would be on improving the patients’ quality of life.
These characteristics enable skilled nursing facilities to effectively achieve efficiency and control in the revenue cycle, an area often fraught with medical complexities and bureaucratic uncertainty.
