Accurate and timely billing is a fundamental aspect of financial success for Skilled Nursing Facilities (SNFs), particularly when it comes to optimizing SNF billing. With Medicare Part A serving as a primary payer for many residents, understanding the intricate landscape of SNF billing is crucial to ensure proper reimbursement and compliance. In this guide, we will explore into essential SNF billing tips to help you optimize your billing processes and navigate the complexities of reimbursement.
Essential SNF Billing Tips
1. Know the SNF Billing Requirements
SNFs bill Medicare Part A using Form CMS-1450 (UB-04) or its electronic equivalent. Submit claims monthly, sequentially, and upon significant events such as a decrease to less than skilled care, discharge, or benefit period exhaustion. These steps are vital for optimizing SNF billing.
2. Understand Medicare’s Prospective Payment System (PPS)
Medicare Part A reimburses SNFs under a PPS, providing a fixed rate per day based on the resident’s classification. Ancillary charges are only allowed for covered days and are included in the PPS rate.
3. Include the Beneficiary Notice Initiative (BNI)
Provide the required notices, such as the Important Message from Medicare (IM) and the Medicare Outpatient Observation Notice (MOON), when applicable, as part of your strategy for optimizing SNF billing.
4. Accurately Code Admission and Discharge Dates
Clearly define the admission and discharge dates, excluding the date of discharge or death as a utilization day. Precise coding is essential for proper reimbursement and plays a crucial role in optimizing SNF billing.
5. Track Leaves of Absence (LOAs)
Report LOAs for non-medical reasons separately. Utilize Condition Code 57 and Occurrence Span Codes 70 and 74 in interim bills during LOAs.
6. Verify Eligibility and Benefits
Confirm residents’ eligibility for Medicare Part A benefits before admission. Track remaining Medicare Part A SNF benefit days to avoid billing for non-covered days.
7. Document Thoroughly
Maintain comprehensive medical records to substantiate billing claims. Ensure accurate patient demographic and insurance information and document all services provided in alignment with billing codes, a critical component of optimizing SNF billing.
8. Stay Updated on Billing Guidelines
Regularly review and adhere to Medicare’s SNF billing guidelines and coding updates. Attend industry training and workshops to stay informed about billing changes.
9. Monitor Denials and Appeals
Review denials promptly, identifying reasons for non-payment. File appeals within 60 days of receiving a denial notice, providing clear and documented evidence to support appeals and further optimizing SNF billing procedures.
10. Consider Outsourcing Billing Services
Ensure billing and coding staff receive regular training to stay informed about changes in regulations, coding guidelines, and best practices specific to SNF billing. Outsourcing billing can alleviate administrative burdens and enhance billing accuracy. Choose a reputable billing company experienced in SNF billing.
By incorporating these SNF billing tips into your practices, you can establish accurate and efficient billing procedures, maximize reimbursement, and minimize the risk of denials and penalties. Stay proactive, stay informed, and ensure that your billing processes align with the ever-evolving landscape of SNF reimbursement.
In the pursuit of accurate and efficient SNF billing, consider partnering with Medisys Data Solutions (MDS), a trusted medical billing company. Medisys specializes in providing comprehensive SNF billing services, ensuring adherence to Medicare guidelines and optimizing reimbursement processes. With a commitment to excellence, Medisys offers tailored solutions to meet your SNF billing requirements. For expert assistance and streamlined billing services, contact Medisys today to elevate your billing efficiency and financial success in the realm of Skilled Nursing Facilities.