Skilled Nursing Facility Medicare Billing

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

Skilled Nursing Facility Medicare BillingThere 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!

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