Skilled Nursing Facilities (SNF) invest their day and night in providing rehabilitative and medical care. Patients recovering from illness, injury, or surgery are mostly benefited by these facilities. Skilled nurses mainly aim to help residents regain their daily living standards.
However, if billing isn’t streamlined with the treatment process, facilities face payer denials. It leads to a significant revenue loss. In addition, at the heart of every skilled nursing facility billing lies attention to detail and steadfast compliance. It establishes the common phrase – “Compliance updates today safeguard tomorrow’s SNF success.”
To be on the safe side, let’s focus on the top 6 SNF billing compliance updates that matter most now. Moreover, we will discuss how clarity and precision guide policy-driven experts toward confident decision-making.
1. Modest Increase in SNF PPS Payments for FY 2026
CMS finalized a 3.2 percent increase in SNF Prospective Payment System (PPS) rates for fiscal year 2026. It is even above the proposed 2.8 percent. This result from a 3.3 percent market basket, plus a 0.6 percent forecast correction, offset by a 0.7 percent productivity adjustment.
This balanced boost supports patient care without compromising financial discipline. Hence, facilities should adjust budgets now. Moreover, they must ensure their SNF billing staff know the updated rate, so they can enter the same. Recording the new rate ensures smoother claim processing.
2. PDPM Parity Adjustment under Review
CMS continues evaluating the Patient-Driven Payment Model (PDPM) parity adjustment. This follows earlier corrections that applied phased reductions in FY 2023 and 2024. The PDPM model ensures the reimbursement is properly aligned with actual cost realities.
It ensures accurate reimbursements, so no party feels deprived.
Furthermore, skilled nursing leaders must monitor parity adjustment developments closely. Many of these adjustments may even alter reimbursement calculations. Hence, facilities must stay proactive to prevent unexpected revenue shortfalls. This aligns billing with evolving case-mix accuracy.
3. SNF QRP Compliance Changes Begin October 2025
New rules for the Quality Reporting Program take effect October 1, 2025. CMS will remove four Social Determinants of Health assessment items. They also revise the reconsideration policy for non-compliance decisions.
Moreover, facilities should update the Minimum Data Set (MDS) tools. They should prepare for simplified SDOH sections. Also, training staff on the new appeal process for compliance letters is pretty essential. Accurate data and appeals safeguard the Annual Payment Update.
4. Expanded Value-Based Purchasing Program
CMS reforms the SNF Value-Based Purchasing Program. It eliminates the Health Equity Adjustment. The scoring methodology now includes the Potentially Preventable Readmission measure. A new reconsideration process also allows appeals on review requests.
These changes shift performance metrics. Hence, facilities should focus on reducing readmissions. They must equip SNF billing solutions to track and optimize outcomes. Appeals offer a second chance. Facilities should prepare and submit documentation accurately to challenge unfair scores.
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5. Revised ICD-10 Code Mapping under PDPM
CMS finalized technical updates to ICD-10 code mappings applicable to represent the PDPM classification system. The primary aim of CMS is to improve coding accuracy for bundled payment calculations. However, bundled codes are pretty complicated, and SNF coders should have in-depth knowledge to apply them properly.
Billers must update coding crosswalks. Ensure that ICD-10 entries align with the new mappings. Accurate coding preserves appropriate reimbursements. Use updated lists immediately to prevent denial risks.
6. Staffing Data and PBJ Oversight Rises
CMS underscores data transparency via Payroll-Based Journal (PBJ) submissions. The organization targets staffing patterns and hours. To ensure maximum accuracy, healthcare regulators scrutinize facility staffing data more closely. Non-compliance may risk penalties or losing public trust.
SNFs must ensure PBJ entries reflect staffing accurately. They should validate hours and categories before the monthly submission. Alternatively, they may invest in data validation tools to prevent unwanted errors. Above all, accurate data supports compliance and reputational trust.
How SNF Billing Outsourcing Services Ensure Compliance
In-house SNF billing staff deal with patient care and administrative complexities at the same time. Consequently, they lack the time to centralize their focus in one domain and commit unfortunate errors. On the other hand, an outsourced skilled nursing facility billing company has dedicated experts who ensure optimum billing accuracy.
This way, outsourcing SNF billing and compliance functions yield practical benefits. Expert billing vendors stay current with CMS updates. They apply coding changes, PPS rate shifts, and QRP modifications instantly. External staff handle appeal workflows efficiently.
In addition, Third-party SNF billing vendors validate PBJ and MDS data before submission. That reduces the risk of errors and penalties. They monitor parity adjustments, mapping updates, and VBP rules. This frees providers to focus on care delivery. Partnership with trusted billing specialists ensures both accuracy and peace of mind.
These six updates—from payment rate tweaks to ICD-10 mapping—shape the SNF billing landscape now. Each directly affects revenue, compliance, or quality scores. Skilled nursing leadership with clear knowledge stays ahead. Thoughtful adjustments and possible outsourcing make compliance simpler and more reliable.
For those who keep billing practices tight, these updates promise stability and smoother operations. Sharing this blog helps peer teams stay informed. Insight today ensures security tomorrow.
