“If billing doesn’t move, the care doesn’t either.” That’s a line overheard at a facility in rural Indiana. The administrator said it while staring at a stack of denied claims. She wasn’t frustrated—just tired. Her skilled nursing facility (SNF) wasn’t doing anything wrong. But mistakes in the SNF billing flow were holding up payments. Days turned into weeks. And the longer it took, the more staff had to explain late checks and bounced services. That’s not an isolated story.
Billing delays, coding errors, and denials have become unavoidable part of SNF billing. And let’s be honest—most of those issues come down to broken or missing steps. What’s needed isn’t more SNF billing staff. It’s more clarity. Below is a real, usable checklist to help SNFs get paid faster and see fewer denials. Nothing fancy. Just practical steps that work.
1. Start with Insurance Verification
Every admission should begin with a real-time eligibility check. Facilities need to check: Is the patient covered under Medicare Part A? Do they have a Medicare Advantage plan? Is there a secondary policy? These are questions that need answers before the patient even walks into the room. Missing one step here can lead to total claim rejection.
Most modern systems allow eligibility checks within minutes. Suppose the SNF doesn’t have one that needs fixing. Also, facilities need to assign one staff member to verify the benefit period and remaining days. Too many denials happen because no one checked how many covered days were left.
2. Get Physician Certifications on Time
Medicare needs a signed certification from the attending physician within five days of SNF admission. After that, the recertification comes on day 14, then every 30 days. There’s no wiggle room. If those dates slip in long-term billing, payments stop.
A reliable way to prevent this is to set auto-reminders in your EHR. Some SNFs also keep a handwritten tracker on the nurse station wall. Whatever works—just make sure those certifications happen without delay. Missed documentation here accounts for thousands of dollars lost every year.
3. Document Everything Right in the MDS
The MDS is more than paperwork. It shapes your payment under PDPM. Every section—from diagnoses to ADLs—impacts how your case mix is scored. Here’s what many facilities miss: Billing and nursing must align. If therapy logs say one thing and the MDS says another, you’re looking at an audit trigger.
SNFs need to hold a short team huddle weekly to review MDS entries. Billing teams should ask questions, not just take the forms as-is. That collaboration saves both time and reimbursement.
4. Assign the Correct Primary Diagnosis on Day 1
PDPM uses the primary diagnosis to set the payment category. One wrong code? You lose money. Hence, don’t guess here. Pull the hospital’s discharge summary. Match the diagnosis with clinical findings. The ICD-10 code must reflect the main reason the patient needs SNF-level care, not just what’s on the hospital record.
Some teams review the diagnosis within 24 hours of admission. That ensures nothing gets missed during the rush of intake.
5. Scrub Claims Before Sending
Scrubbing doesn’t mean just checking for blanks. It means reviewing for accuracy, consistency, and compliance. Facilities must run every claim through a billing tool that flags missing modifiers, wrong dates, or duplicate charges. Then review it again with human eyes.
Even a small mismatch in room charges or therapy minutes can delay a payment by weeks. Fixing it later takes three times as long as doing it right up front.
6. Track Every Denial and Learn from It
Denials shouldn’t be ignored. They should be dissected. SNF billing staff need to make a habit of logging every denial reason. Sort them by issue type—eligibility, documentation, coding. Then fix the system causing that issue.
Most importantly, fight back. Facilities must swiftly appeal with the right documents. A proper and timely appeal will help the facility in collecting accurate and swift reimbursement.
7. Follow the Right Metrics Every Week
SNF billing experts should track the following metrics for info-driven insights on claim performance:
• Clean claim rate
• Denial percentage
• Days in A/R
• Reimbursement per PDPM level
If A/R crosses 40 days, something’s not right. If clean claims fall below 95%, it’s time for an internal review. Facilities should post these numbers where every department can see them. That visibility creates accountability and pride when those numbers improve.
Finally, Outsourced SNF Billing Services Ensure Faster Payment
There’s no magic in getting paid faster. Just clear steps, done consistently. However, small-scale facilities often find it harder to employ a team of billing experts due to a strict budget. Here, SNF billing outsourcing offers a result-driven and most affordable solution. They have a team of dedicated and qualified billing experts who can maintain maximum billing accuracy.
Moreover, some SNF billing companies offer billing and RCM services for just $7 per hour. With their assistance, facilities cannot only save 80% of administrative expenses but also get ample time to focus on care.
