Since skilled nursing facilities (SNFs) were allowed to bill for their services independently up until 1998, nurse center billing was a very simple process. The Balance Budget Act took effect in 1998, and since then, there have been changes to the way SNFs submit claims for payment. The following points will list the modifications :

Problems with Billing in Skilled Nursing Facilities

In order to produce SNF claims as part of consolidated billing, one must be knowledgeable about codes and understand what is and is not covered by Medicare A. Medicare B may provide coverage for items that Medicare A does not. That needs to be recognised by the SNF and billed individually.

However, payment on a per diem basis refers to a set sum that CMS provides to SNFs under Medicare A, which SNFs use to cover the cost of contracted nursing services.

• As part of consolidated billing under the Prospective Payment System, SNFs are now required to submit their claim (PPS)
• Medicare A pays SNFs on a per diem basis.

The following issues are encountered by nursing facilities:

• Application of inaccurate codes that results in claim rejection
• Inadequate awareness of the products covered by Medicare A and B
• Given that the range of services provided by facilities has some cost elasticity, which the set rates frequently fail to capture, fixed or per diem payments for services that do not appropriately accommodate costs borne by the nursing home.

The two possibilities mentioned above expose nursing homes to two different types of income leakage: underpayment of services and rejected claims.

Furthermore, it’s frequently challenging to prove that a patient needed the care given by a nursing home and that they spent an excessive amount of time engaging in non-medical activities.

Billing for Skilled Nurse Facilities is Outsourced to PBC

PBC has assisted nursing homes in all 50 US states, both rural and urban (with a greater emphasis on rural areas due to the concentration of nursing facilities there), in growing their revenue streams by lowering the percentage of reimbursement rejections and putting a greater emphasis on nursing services. With their in-depth understanding of the nuances of billing and coding, PBC’s billers and coders are equipped to handle every step of the billing and coding process, from determining a patient’s eligibility for reimbursement to precisely classifying products as covered by Medicare A and Medicare B. Additionally, they follow up after claims are submitted to make sure CMS reimburses payments on time.

You can select a solution that best suits your requirements and setup thanks to our adaptable service models. We provide a variety of service options, one of which is the “in-house” service model, in which providers use the PBC employment portal to find internal skilled nursing facility billers and coders.

If you don’t already have a team of billers and coders on staff or don’t think you need one, our outsourced billing and coding model can assist. It will allow you to delegate all of your billing and coding duties to us, freeing you up to focus entirely on providing nursing care. Our outsourcing strategy covers all aspect of billing and coding, from determining the patient’s insurance eligibility to filing claims and following up after submission.

In order to identify areas of revenue leakage and plug them, our RCM consulting model entails a thorough analysis of your revenue management cycle. This includes helping to replace ineffective software applications with new ones that are tailored to your needs and environment, as well as assistance with employee training when needed.

The PBC national network also has local expertise and familiarity, which helps us comprehend your working environment and assist you in meeting location-and state-specific needs.