In skilled nursing facility domain, billing and coding are the easy affair. At the end of the day, you want to ensure that you are not wasting your heard earned money. With certified billers and coders and an efficient revenue cycle management process, you can drastically improve your financial performance.
In your SNF billing solutions, you must submit claims to health insurance companies to receive maximized reimbursements for the provided skilled nursing care services to your patients. A proper skilled nursing facility billing method ensures you are properly paid by billing your patients and their insurance companies. Always remember one thing that timely and accurate reimbursement is the key to your practice’s overall success. In your skilled nursing facility solutions, medical billing plays one of most vital roles.
The SNF coding is a standard procedure of converting a patient’s medical diagnoses and treatments into alphanumerical codes that your administrative team and insurance companies can easily decipher. Each skilled nursing care procedure comes with a unique code which is used for calculating the cost of provided care. After your medical records are coded, your internal biller sends a payment request to your insurance company. Once the claim is reviewed and insurance is applied, the biller figures out how much you still owe.
Fortunately, you can ensure a skilled nursing facility billing services by implementing the steps mentioned below-
10 steps involved in your SNF billing solutions:
1) Patient registration:
Every visit, no matter how long you’ve been seeing the patient, should begin with some form of enrollment. During the first meeting, you’ll need to gather the patient’s medical history and basic information for your records.
Make sure you have all the key details, like the patient’s address, phone number, and insurance info, especially for routine cases. Confirming their date of birth, insurance card, or address ensures everything is accurate in their file.
2) Diligent insurance verification:
Make sure you have the patient’s insurance info updated and accurate during enrollment. Also, check if any new visits require special billing, like for worker’s compensation or an accident. Using effective skilled nursing facility billing mechanism can make handling insurance much easier for you.
At this stage, you confirm the patient’s insurance is up to date, check their info is accurate, and review their out-of-pocket costs. Doing this now helps you avoid billing issues and delays later on.
3) Record accurate patient information:
During the visit, make sure you record all the details discussed. Take good notes or, if possible, record the meeting (audio or video). Afterward, a medical coder will review this info to apply the correct codes to the visit.
After the visit, the meeting might be transcribed. Make sure the purpose of the visit is clear, diagnoses are included, and all details are covered. This helps your billing and coding team and provides the patient with a more complete medical history for future reference.
4) Assign accurate codes:
You or your coding team will decide if a CPT or HCPCS code is right for the services you provided. Make sure bundled services aren’t billed separately, and choose the code that best matches the work you’ve done.
You or your coders will need to choose the right ICD-10 codes for the patient’s diagnosis. There are around 70,000 codes to pick from; compared to just 13,000 in the old ICD-9 system—five times more! That’s why the details you include in the patient’s medical records are so important.
5) Obtain prior authorization approvals:
There are specific skilled nursing care procedures that you require you to obtain prior authorization approvals from your patients’ insurance companies. You should always receive the PA approvals before providing those specific care services or treatments to your patients. Without having the prior authorization approval, you may encounter claims rejections and uncalled out-of-pocket expenses for your patients.
6) Charge entry:
Your billing team will now create the medical claim using the visit codes. It’s crucial to use the correct codes because the wrong one can change the charges a lot. Also, the costs can vary, even if the codes look similar.
Make sure you include all costs in the list with the correct visit codes. A clear list of medical services helps you avoid mistakes and speeds up the process. If errors occur, the insurer might deny your claims or refuse to pay, which could also affect any out-of-pocket costs for the patient.
7) Review and submit claims:
After everything has been checked for accuracy, you’ll need to file a claim for payment. This can often be done electronically and usually goes through two review steps: one for cleaning up the data and another for final checking. The software helps ensure all fields are filled out correctly and that the codes and charges make sense.
Next, they send the claims to a clearinghouse for a final check. After reviewing the key details (like name, current insurance, and date of birth), they reformat the claim for each payer, since not all payers use the same format.
8) Perform insurance adjudication:
At this stage, the insurance provider will review the claim to see if the treatments or procedures are included and will either approve or deny it. If there are any mistakes, the claim won’t be removed; instead, you’ll receive a detailed explanation and instructions on how to fix the issues. Once you’ve made the corrections, you can resubmit the claim.
Sometimes, they might reject the claim because the insurance doesn’t cover the services. This is where your initial work pays off, especially regarding the patient’s insurance details. It’s important to know what’s covered to avoid issues later on.
9) Draft patient statement:
Prepare statements for the patient, assuming all the information is correct. If the total isn’t zero, clearly explain the charges and what the insurer covers. This way, they understand the costs and how much they owe. Also, provide details on how to make payments, deadlines, and how they can dispute costs with their insurance.
10) Payments follow up:
Entering payments from the patient and the insurer completes the process. Once claims are approved, payments to insurance companies happen automatically. Patients can also choose to prepay for a procedure or make a co-pay for a visit. Some may decide to pay in advance at a younger age.
While every stage of the process is important, getting paid for your services is what allows you to earn money, pay your staff, and keep your operations running. You may need to handle collections, but you must meet deadlines with your cases before you start receiving payments.
If you don’t have enough staff to handle your SNF’s billing, you can outsource the entire administrative process to a top SNF billing company like Sunknowledge. The great thing about outsourcing your skilled nursing facility billing to a SNF billing solution company is that it lets you focus on providing clinical care, while your billing partner works to improve your revenue by efficiently managing the entire billing process.