Until 1998, nurse center billing was quite simple to do because skilled nurse facilities (SNFs) could bill separately for their service. Since 1998, after the Balanced Budget Act came into effect, various things about how SNFs claim their reimbursement have changed.
The points below will outline the changes:
Challenges of Skilled Nursing Facility Billing
Generating SNF claims as part of consolidated billing requires the knowledge of codes as also familiarity with what is covered by Medicare A and what’s not. If something is not covered by Medicare A, then it may be covered by Medicare B. The SNF has to identify that and bill it separately.
On the other hand, payment daily means a fixed amount CMS pays to SNFs under Medicare A with which SNFs pay contracted nursing service providers for their services.
- At present SNFs have to generate their claim as part of consolidated billing under the Prospective Payment System (PPS).
- SNFs are paid by Medicare A on daily basis.
Nursing Facilities problems
Nursing Facilities are exposed to the following problems:
- Applying Inaccurate codes leads to the rejection of claims.
- Insufficient knowledge of items covered by Medicare A and B
- Fixed or daily payments for services not accommodating cost abide by the nursing facility sufficiently- given that there is a proportion of cost elasticity in the range of services rendered by facilities, which the fixed rates often fail to confine.
The above-given scenarios expose nursing facilities to two kinds of revenue leakage: one is via rejected claims; another is through underpayment of services.
Moreover, it’s often hard to indicate that the patient needs the services provided by a nursing facility and excessive time spent on non-medical activities.
Outsourcing Skilled Nurse Facility Billing to ZMB
ZMB has helped nursing centers in rural and urban US (more rural areas as that’s where nursing facilities are mostly concentrated), improving their revenues by reducing reimbursement rejection rates and increasing their focus on nursing services.
ZMB’s billers and coders have a vast knowledge of billing and coding complexities. So that they can take care of the entire cycle of billing and coding needs starting from identifying patient eligibility for reimbursement to accurately isolating items covered by Medicare A and Medicare B. They also carry out post-claim-submission follow-ups to ensure timely reimbursement of payments by CMS.
Our flexible service models assure that you can select a solution that fits your requirements and setup. We offer wide service models including an in-house service model; where providers can source in-house skilled nursing facility billers and coders.
If you don’t have an in-house team of billers and coders nor any need to have one, our outsourced billing and coding model will help you. You can ship out all your billing and coding responsibilities to us so that you can entirely focus on the delivery of nursing care. Our outsourcing model includes the entire range of billing and coding activities, starting from identifying the patient’s insurance eligibility to submission of claims and post-submission follow-ups.
Our RCM advising model involves an in-depth study of your revenue management cycle. That is to identify areas of revenue leakage and plug them by helping reduce outdated or inconvenient processes.
ZMB also comes with local understanding and familiarity so that we know your operating environment and help you meet your state-and-area-specific needs.
Get a free no-sting attached billing services quote from ZEE Medical Billing for your practice.