Proven Strategies for Overcoming Billing Obstacles in Skilled Nursing Facility Residents

Proven Strategies for Overcoming Billing Obstacles in Skilled Nursing Facility Residents

A consistent and stable revenue stream is required to run a cost-effective and efficient skilled nursing facility. Unfortunately, if your billing efforts aren't optimized for success, that will be difficult to achieve. SNF billing obstacles harm your skilled nursing facility residents, whether they result in late payments, denials, patient complaints, or even missed deadlines. Obstacles elimination is vital to your bottom line, so consider the most prevalent SNF billing obstacles and develop strategies to prevent them from affecting your revenue cycle management.

Obstacle #1: Regulatory Compliance

If these standards are not followed, penalties or fines may be imposed, which can be detrimental to the financial health of skilled nursing facilities.
  • HIPAA
  • ICD-10
  • Affordable Care Act
  • Medicare and Medicaid
  • Fee Schedules and Reimbursement Regulations
  • State and Local Regulations

Obstacle #2: Staff Training and Education

Staff education and training can be challenging, especially in a fast-changing healthcare system prevailing in skilled nursing facilities.
  • High Staff Turnover
  • Lack of Healthcare Facilities
  • Technology Changes

Obstacle #3: Technology Integration

Technology integration is critical for effective and efficient revenue cycle management (RCM) since it can assist in streamlining procedures and reduce the likelihood of errors. However, technology integration can bring several obstacles.
  • Technology Overload
  • Data Security Issues
  • Compatibility Issues
  • Healthcare Costs

Obstacle #4: Denials and Appeals

Revenue cycle management (RCM) frequently encounters issues with denials and appeals, which can significantly impact how well a skilled nursing facility makes money.
  • Complex Regulations
  • Lack of Documentation
  • Inefficient Appeals Processes
  • Insufficient Resources
  • Communication Issues

Obstacle #5: Financial Management

When there is adequate financial management, revenue cycle management (RCM) in skilled nursing facilities works well.
  • Poor Cost Containment Practices
  • Revenue Leakage
  • Manual Processes
  • Changing Payment Models
  • Payer Contract Negotiations

Obstacle #6: SNF Billing and Coding

SNF billing and coding can be complex and error-prone, causing payments to be delayed or claims to be denied.
  • Coding Accuracy
  • Code Changes
  • Upcoding and Downcoding
  • Coordination of Benefits

How To Handle Billing Obstacles in Skilled Nursing Facility Residents?

  • Review Charge Description Manager (CDM)
To enhance reimbursement collections, SNF practitioners must properly communicate suspense times to departments and state them in their procedures and regulations. Suspense times are rigorous deadlines that skilled nursing facilities must meet in order to enter compliant, audited, and correct charges for each delivered treatment.

Each day that charges are not entered and the suspense time is lost might have a detrimental impact on the SNFs outstanding cash receivables and cash flow. As a result, a thorough examination of the charge description manager (CDM) is required to guarantee that facilities collect every penny correctly and do not leave any money on the table.

  • Meet Filing Deadlines
Many SNF practitioners have unmonitored and inefficient systems. As a result, they either do not file initial claims or do not reply to claim appeals. SNF practitioners can submit initial claims to Medicare within 12 months of the date of service. It also allows them to reply to claim denials within 120 days.

However, several commercial payers have rigidly limited the claim submission time to 90 days due to unique state and payer rules. As a result, it is recommended to have mechanisms in place to file timely claims and monitor claims on hold frequently to ensure that deadlines are not missed.

  • Denial Management
Monitoring, reporting, and tracking rejections are all aspects of a successful denial management system. Identifying the causes of denials is critical before establishing an efficient revenue cycle management plan. A follow-up procedure allows the SNF biller to determine if a claim has been accepted or refused.

In the event of a denial, SNF billers should concentrate on resubmitting claims after eliminating the causes of the rejection and ensuring that the same problems are not repeated in future submissions. It will help to improve revenue cycle efficiency by lowering claim denial rates. Furthermore, to avoid future denials, skilled nursing facilities should convey denials and report by:

  • Payer and type, reason, and department
  • Percentage of revenue submitted
  • Denied claims as a percentage of the gross revenue

Outsourcing to 24/7 Medical Billing Services!

Your skilled nursing facilities do a lot for your patient’s physical health, but what about their financial health? SNF billing obstacles can give patients much trouble, especially if they believe their practitioner isn't doing enough to assist them in comprehending their bills and fixing any SNF billing errors that arise.

Due to budget constraints, personnel challenges, or other considerations, not every practitioner can assist patients in resolving SNF billing issues. However, if you want to improve your patient’s overall experience with your skilled nursing facility, ensure they have an ally while negotiating the obstacles of snf medical billing. The most optimum solution to focus on a patient-centered approach is outsourcing to 24/7 Medical Billing Services.

24/7 Medical Billing Services has assisted skilled nursing facilities in streamlining their billing practices for decades as an experienced SNF billing and coding partner. We've worked with a wide range of practices and EHR systems, allowing us to put in place the best strategies to help your skilled nursing facility raise total clean claims and maximize revenue cycle management.

See also: A Beginner’s Guide To SNF Medical Billing Services