What is a Skilled Nursing Home Billing?
Providing services and continuous care for residents who require constant medical or nursing care or in case of rehabilitation services for the recovery or even the perpetual care for the disabled, sick persons etc, the billing process for this service rendered is known as skilled nursing home billing. A skilled nursing home billing process requires the skills of qualified technical or professional health personnel, such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech language pathologists or audiologists.
Skilled Nursing Facility is mostly rendered for an ongoing condition for which the beneficiary also received inpatient hospital facility mostly ordered by a physician.
Challenges of Skilled Nursing Facility Billing:
Keeping up with the present billing mandates and ever-changing billing regulation of Skilled Nursing Facility Billing is one of the biggest challenges as with the ever-changing billing regulation and continuous change in the billing mandates, producing Skilled Nursing Facility Billing claims as part of consolidated billing requires complete knowledge of codes related to skilled nursing facility billing. As well as being familiarity is equally important with what is covered by Medicare A and what’s not which many billers and coders lack.
Sunknowledge’s Advantage on Skilled Nursing Facility billing
Working for more than a decade today, we are today only known for our highest productivity metrics but also for excellent client references. Helping in closing all the skilled nursing facilities faster and efficiently, we are the part of many operational extensions for top leading skilled nursing home facilities today; helping them with a faster reimbursement rate and seamless billing management partnering with us for Skilled Nursing Facility billing our client’s benefits starts with our all facilities.
An Expert in Skilled Nursing Facility Medicare Billing
If you are a skilled nursing home facility, value based care will only be possible if you have the right perspectives in place with your administrative priorities. Patients today are looking for more personalization in their care and they look for proactive assistance. A smooth connect between your front and back office will be important and you need specialized assistance especially with Medicare skilled nursing facility billing.
The difference we make in your skilled nursing home facility needs
Sunknowledge Services Inc understands the claims adjudication mandates of the industry better than any medical billing and collections company. We are working with leading Medicare Skilled Nursing Home Facilities and proficient across all major practice management/ billing software in the country. We work as an extension to your Long term care billing demands.
We provide our complete support ensuring the right checks and balances with streamlined prior authorization, implement functional best practices that better your denial management efforts, a comprehensive accounts receivable recovery process.
A look at our AR management process
Our A/R follow-up service is designed to increase the Revenue Collection for our clients. The process begins after the Provider creates and sends Health Insurance Claims (Electronic/Paper claims or Manual HCFA forms) to various Insurance Companies. Depending on the transmission type and length of time since submission, we begin our follow-ups.
Key steps in Accounts receivable follow up
- Online Claims Follow-Up
Using various insurance company websites and Internet payer portals, we check on the status of outstanding claims.
- Automated Claims Follow-Up (IVR)
By calling insurance companies directly, an Interactive Voice Response (IVR) system will provide the status of unpaid claims.
- Insurance Company Representative
If necessary, calling a ‘live’ insurance company representative will give us a more detailed reason for claim denials when such information is not available by the first 2 methods.
Denial Management best practices
There are multiple reasons due to which a claim is denied. We provide our end to end implementation assistance that betters your denial management attributes in your skilled nursing home care billing. Some of the causes :
- Authorization Issues
- Referral Issues
- Medical Necessity and Medical Records requests
- Non-Participation with Insurance Network
- Terminated Insurance
- Coordination of benefits
- Wrong Diagnosis
- Inclusive Procedures
- Partial Payments
- Out-of-network claim status and deductibles
- EDI Rejections
- No status and No claim on File
- PIP cases
How we help:
- Claim Correction and Resubmission
These are the claims which are corrected, modified, and resubmitted as a corrected claim to Insurance companies.
For such claims, every effort is made to resolve the denial to avoid billing the patient.
- Patients’ Responsibility
These are claims which cannot be further worked upon and the final bill is sent to the patient for payment collection.
The reasons for sending the patient a bill generally include In-Network deductibles and non-covered benefits as per the insurance plan. Patients receive a statement with a clear explanation for the balance due.
Leverage on the Sunknowledge advantage ensuring:
- Reduction in accounts receivable by 30% within 1 month
- Demonstrated expertise in working on difficult-to-recover aging A/R
- Expert handling of accounts receivable by highly experienced staff
- Over 7 years’ experience in claim adjudication for major US insurance plans
We are just a call away from you: Let us share our credentials and compliment your medical billing efforts like none other!
Talk to us!
Why Would I Want To Outsource My Skilled Nursing Facility Billing?
Skilled nursing facility billing is quite different from other medical billing processes. Saying so, for a skilled nursing home facility be it for code entry or producing the SNF claims or timely claims submission; which is considered as the part of consolidated billing, complete awareness of codes, process knowledge, and also familiarity with what is covered by Medicare A and what’s not is very essential for an error-free skilled nursing home billing facility. However, this often leads to regularly be up to date with the present industry regulation and keep a complete recent knowledge on all the Medicare services as well, which often becomes a real challenge for in-house SNF billers and coders.
Moreover, having a team of SNF is quite an expensive affair, where outsourcing can offer better-skilled nursing facility services that to at a cost-effective rate of $7 per hour; saving you from not only waste a large amount of money but also time. This is why outsourcing is always a better option for a skilled nursing home facility providing a seamless billing option.
Are You An Established Skilled Nursing Facility Billing Company?
Working for more than a decade today, we are today only known for our highest productivity metrics but also for excellent client references. Helping in closing all the skilled nursing facilities faster and efficiently, we are part of many operational extensions for top leading skilled nursing home facilities today; helping them with a faster reimbursement rate and seamless billing management.
Will You Be Able To Handle Billing Information Securely?
Following-up directly from the doctor’s office, we have also a track record of a 99.9% accuracy rate in all the billing and coding processes. In fact, we are a complete HIPAA- HITECH compliant operations offering a Hiscox /Geico insurance program to protect our clients from noncompliance, which has a liability cover of $2 million.
Do You Have Expertise In The Software I Use?
With an up to date knowledge of software like Brightree, Kareo, Futura, Universal, CPR +, and many more our experts are proficient in the different billing software. With the ability to work on any client’s proprietary software seamlessly, we further help with a faster reimbursement rate and better Skilled Nursing Facility Billing management.
How Will Your Work On Denials And Collections?
We have an excellent track record in working with aging accounts receivable as old as 120 days. Our team works out a plan of action on which accounts to target, submit according to timely filing limits, understand what is delaying or denying payments, and introduce corrective measures. We start our collections process from accounts with the oldest one: 90-120 days or greater, 60-90 days, 30-60 days. We do not write off or do any adjustments without our client’s consent. As we make sure that every account is targeted, a dollar value is not the defining factor. Based on this approach, we have proven success stories of collecting 90-95% of the claims submitted.
What Experience/Certifications Do You Have In Skilled Nursing Facility Billing?
With more than 15 years of experience in working on Skilled Nursing Facility Billing, our pool of experts further has complete knowledge about:
• Billing and regulatory concepts relevant to skilled nursing facilities
• ICD-10-CM coding for skilled nursing facilities
• E/M coding for skilled nursing facilities
• CPT® coding for skilled nursing facilities
• Case studies for practical application of coding skills