A Beginner's Guide to SNF Medical Billing Services

Healthcare experts, such as physicians and nurses, are always busy giving healthcare aid in a Skilled Nursing Facility, regardless of their medical expertise. Patients come here for any further or ongoing care they may require after being discharged from hospitals. An SNF generally serves in several roles and is staffed with specialists that provide various services on time and at a reasonable rate. Let us look at some of the services and SNF medical billing guidelines required by an SNF to enhance the reimbursement rates:

Services Offered by Skilled Nursing Facilities

• Long Term Care (LTC):

Patients who require a range of services - both non-medical and medical - due to a disability or chronic illness or who are unable to support themselves for extended periods of time. Patients who require on-site supervised care, such as medical services or cleaning, can benefit from LTC.

• Skilled Nursing Aid:

Patients who require medical help such as dressing changes, IV therapy, injections, and medical administration.

• Rehabilitation Care:

Patients who require prompt occupational therapy to fully or partially recover after a significant injury or surgery are considered to need rehabilitation care.

Certified nursing assistants (CNAs), licensed practical nurses (LPNs), and many other non-physician workers are certified to provide various types of support in a Skilled Nursing Facility. The admitting doctor, however, makes the initial doctor's visit, as required by long-term care regulations.

SNF Medical Billing Services Guidelines

• Appropriate Codes Used

Physicians must code accurately to appropriately capture a patient's Skilled Nursing Facility medical record. Skilled Nursing Facilities must follow CPT codes to create accurate and appropriate medical reports, as mandated by federal rules. However, these are only a few of the many codes they must typically manage.

On a daily basis, a Skilled Nursing Facility must use CPT codes such as 99310, 99308, 99307, and 99309 to report federally compliant medically necessary E/M and physician E/M visits.

However, insurance providers are barred by federal laws and procedures from paying for more than one Evaluation and Management (E/M) visit performed by any non-physician practitioner or healthcare professional on the same date of service or for the same patient.

• Period of Coverage of Bill

The SNF typically bills its residents monthly for services rendered and medical care given. The resident (or their legal representative) signs a contract with the care facility. This contract specifies the billing frequency.

This bill primarily contains the cost of all necessary services delivered. However, it may also cover the cost of other related services.

The Skilled Nursing Facility billing cycle is the period (measured in days - for example, a month) during each billing. The nursing facility may then assess a prorated fee for the month of admission. This indicates that if the resident did not begin his stay on the first day of the billing cycle, the billing amount equals the per-day room and board rate multiplied by the number of days. Care facilities may also issue a pre-bill for the expense of the forthcoming month.

• Absence Leaves

This is another aspect that influences the Skilled Nursing Facility bill. A person may need to leave the Skilled Nursing Facility for a short period. They or their proxy will usually sign the bed hold waiver to reserve their room in their absence.

However, this indicates that the care facility will continue to bill the patient even when he is absent. Alternatively, the inpatient could waive the bed hold, resulting in lower expenses but the potential of a room being unavailable when the resident returns.

• Outsourcing Skilled Nursing Facility Billing

What happens when insurance companies cannot correctly read the medical documentation of a Skilled Nursing Facility? In such cases, a healthcare provider risks suffering payment delays or denying their claim. Skilled Nursing Facility billing and coding is incredibly crucial in terms of documentation and reimbursement within the healthcare arena. These billing and coding serve as a universal language for healthcare professionals and insurance providers to comprehend the patient's medical history and condition.

To avoid a catastrophe caused by incorrect Skilled Nursing Facility billing and coding, outsourcing to professionals like 24/7 Medical Billing Services is highly recommendable. Contact their experienced RCM providers with a team of professionally trained Skilled Nursing Facility medical coders and billers to manage all billing and coding activities and collect payment from insurance providers on time.

See also: Requirements For SNF Consolidated Billing (CB)