Skilled nursing facilities (SNF) acts as a bridge between hospitals and home healthcare. These facilities render patients with skilled nursing and rehabilitative care. It is important to note that the billing and reimbursement processes behind patient care are extremely complex. You will need to be well versed in the billing practices associated with SNFs. It is also critical that all healthcare providers understand the elements associated with SNF billing so that patients can better understand the costs of receiving healthcare services through SNFs.
Know the Step-by-Step Process of Skilled Nursing Facility Billing
SNFs typically request reimbursement for a wide variety of types of service provided to the patients including nursing services and physical therapy services, occupational therapy, speech therapy and administration of medications. Each of these services falls into a separate billing code, which means that SNFs must adhere to a variety of different regulatory requirements and processes in order to bill correctly for each of these services. Below are the steps for successful SNF billing:
1) Patient Information & Insurance Verification
The initial step involves collecting patient’s personal details, such as the full name, date of birth, gender, and address. Additionally, it is vital to gather insurance details that includes Medicare, Medicaid or any private insurance. The information should be correct as even minor mistakes can cause delays or payment denials.
Also, it is mandatory to check whether the patient’s insurance covers the services provided. The insurance verification confirms whether the patient qualifies for hospital stay. SNFs prevent coverage gaps, reduce claim denials, and ensure a smooth billing process throughout the patient’s stay. This is done by confirming benefits upfront and documenting everything clearly.
2) Proper Documentation
It is mandatory to record all the services provided to the patient that includes nursing care, therapies, and medication. Each service must be linked to the correct codes. These codes help insurance companies understand the type of care provided.
3) Allocating ICD-10 codes and Procedure Codes
The main diagnosis must be written first using ICD-10 codes, followed by any other conditions that affect the patient’s care. Accurate coding is very important as it explains why the services were necessary. Some commonly used ICD-10 codes include:
- I50.9 – Heart failure
- I63.9 – Cerebral infarction
- J18.9 – Pneumonia
- Common CPT Codes include:
- 99304 – Initial nursing facility care
- 97110 – Therapeutic exercise
- G0154 – Skilled nursing services
4) Charges and Billing
Enter the charges and billing units after recording the services,. This includes daily room charges, the number of therapy minutes, the cost of medications, and any medical supplies used.
5) Claim Submission
The final step is sending the claim to the insurance company. Submitting claims electronically is faster, more accurate, and more secure than using paper forms.
Challenges in SNF Billing
There are numerous challenges that lead to complexity in skilled nursing facility billing. One such challenge is the variable length of stay for patients. Since PPS payments are typically calculated on a per day basis, it is important to accurately communicate and document both current patient needs and changes in patient need over time. Another challenge is changing Medicare regulations and policy. Facilities must stay up-to-date with coding updates, policy changes, and documentation standards.
In addition, when patients move from the hospital to an SNF, the two locations’ billing periods sometimes overlap. This can result in situations where there is confusion over what is paid and when billing occurs or overlap in billing. Payment for each type of care must be clearly defined, as only medically necessary skilled care is eligible for Medicare reimbursement.
Best Practices in SNF Billing
To help improve the accuracy of the billing process and limit the potential for compliance issues, SNFs should utilize best practices in their billing department. They should provide comprehensive training on coding practices, documentation, and regulatory compliance to all staff responsible for coding, documentation, and understanding of federal requirements. Additionally, conducting periodic internal audits to correct errors prior to claim submission will assist SNFs in submitting accurate claims.
By communicating effectively with one another, both the medical department and billing department ensure accurate coding of all services provided in addition to providing proper documentation of all patient care provided.
Organizations work with experienced legal and compliance professionals to ensure compliance with federal regulations and standards.
The billing process of a skilled nursing facility is a difficult and complex process that requires a great deal of attention; however, if done properly, an organization will be able to obtain appropriate reimbursement from Medicare and remain compliant with Medicare guidelines. SNFs must be flexible and employ innovative uses of technology and experts to overcome the obstacles present in SNF billing. By having a firm grasps of the complexities of SNF billing, administrators will be better able to focus on providing high-quality care to their patients and maximize their financial performance for both the facility and its residents.
Through outsourcing, practices can lower their operation costs by up to 80% with hourly rate starting at $7 per hour. It reduces administrative burden for the providers and helps in better patient care. Additionally, outsourcing helps healthcare providers to streamline the end-to-end revenue cycle management.
