Face Off with Skilled Nursing Facilities Billing Challenges

People generally use the terminology ‘skilled nursing’ to indicate a nursing facility that’s staffed with licensed practical nurses (LPNs), doctors, therapists, speech pathologists, and certified nursing assistants (CNAs) to support patients who are recovering from a serious injury, surgery, and chronic medical condition.

Skilled nursing facilities are mostly regulated by CMS (Centers for Medicare & Medicaid Services). To get certified by CMS, SNF communities need to meet specific criteria and are subject to inspections assuring quality standards are met.

Types of services provided by SNF

  • Nutrition care helps in increasing the patient’s recovery by providing nourishing foods addressing to patient’s personal dietary requirements to support their medical condition
  • Skilled nursing facilities provide cardiac care for patients who are aged 65+ or more and who have undergone cardiac procedures or attacks due to high blood pressure, cardiac arrest, and heart surgery
  • This type of therapy helps in improving communication, cognition, and ingestion functionalities for patients who are recuperating from stroke, or other medical ailments
  • Some skilled nursing facilities provide custodial care, meaning supporting patients who have issues handling their own daily activities such as eating, dressing, bathing, and medication requirements
  • Physical therapies or physiotherapy are specially designed exercises that help patients with pain relief, muscle functioning, joint improvement, restoring balance in the body, etc.

Skilled Nursing Facility Billing Challenges

Each and every skilled nursing facility in the US healthcare sector needs to ensure they get timely reimbursements from payers and payments from patients. To achieve this, skilled nursing facilities need to maintain a proper revenue cycle management practice. Here are some top challenges in skilled nursing facility’s billing services:

  • Some skilled nursing homes do not have a properly experienced team of medical billers, who knows how to and in what ways a billing can be created, submission of claims, following-up with payers (insurance companies), ensuring patient’s insurance information, and many others. If the skilled nursing facility billing team has a problem communicating or working with the SNF practice management, then that facility’s revenue cycle will suffer
  • It is highly essential to track claims and denials, nearly 5% of claims get denied and 50% of denied claims are not resubmitted for reimbursements. The above figures indicate how much revenue loss a skilled nursing facility incurs due to improper or unable to track claims and resubmit clean claims
  • A clean claim can only be submitted to payers when the skilled nursing facility has captured accurate patient medical documentation, patient’s insurance information, physician information, and services rendered. A small error in billing or medical documentation can lead to claim denials or reimbursement rejections

Benefits of Skilled Nursing Facility

  • Skilled nursing facilities always try their best to provide and restore quality of life for patients who are being given medical care by doctors and nurses. SNF care teams can help a patient to regain his/her strength, dignity, and self-respect
  • Proper nutrition is the key to any individual’s optimum level of health. To recover from serious medical conditions, surgery, injury, or any other kinds of medical ailments
  • One of the most beneficial factors of skilled nursing facilities is lowered costs because patients who have Medicare will get cost coverage of 100 days to stay in a skilled nursing facility if certain eligibility criteria(s) are met

Solutions to Mitigate SNF Billing Challenges

One of the best and most reliable options to mitigate all these challenges in skilled nursing facilities billing is to start outsourcing the SNF coding and billing to a knowledgeable revenue cycle management company. Sunknowledge Services, Inc. is a revenue cycle management company providing skilled nursing facility billing assistance, DME & HME billing support, payor solutions, and many more. Our tailored revenue cycle management (RCM) solutions allow healthcare providers to reduce administrative losses, and increase their additional revenue.