Running a skilled nursing facility (SNF) requires accurate billing. However, it can be challenging with all the rules, insurance claims, and complex processes involved. Don’t worry—this blog will cover the best practices to help make your billing process smoother and more efficient.

What is Skilled Nursing Facility Billing? 

Billing for a skilled nursing facility means submitting claims to insurance, Medicare, and Medicaid for your patients’ care. SNF billing is different from regular medical billing because it involves specialized care. To get it right, you need to know the rules and what the insurance companies expect.

Challenges in SNF Billing 

1. Keeping up with regulations: Medicare and Medicaid policies are constantly changing, and it’s easy to fall behind.
2. Understanding complex codes: Many billing codes must be learned, especially ICD-10 and CPT codes that apply specifically to SNFs.
3. Handling claim denials: Coding mistakes or missing documentation often cause claims to get rejected.
4. Avoiding revenue loss: Errors like underbilling or submitting claims late can lead to lost income.

Best Practices for SNF Billing 

1. Document Everything Clearly—Proper documentation is essential. Make sure your team records all patient details and services provided. This will help avoid mistakes and keep you compliant with the rules.
2. Keep Up with Changes – Billing rules and regulations change often. Stay updated on new billing codes and Medicare/Medicaid guidelines to avoid issues. Attending workshops or webinars is a good way to keep your team sharp.
3. Use the Right Billing Software – Invest in billing software designed for SNFs. It can save you a lot of time and help you catch errors. Look for software that can automatically submit claims and track their status so you’re not left guessing.
4.  Audit Regularly—Perform regular audits to spot mistakes or missed revenue. These audits can help you identify areas where your team may be over- or under-coding, allowing you to make adjustments.
5.  Keep Your Team Trained—Billing staff should always know the latest coding standards and payer rules. Offer regular training to help them stay up-to-date and make fewer mistakes.
6. Outsource When Necessary – If billing is too much to handle in-house, consider working with experts. Outsourcing can reduce claim denials and free up your time to focus on patient care.
7. Build Strong Relationships with Payers—Clear communication with insurance companies and government payers goes a long way. If a claim appears suspicious, proactively resolving issues can help avoid rejection.

How to Improve Your Revenue Cycle Management (RCM) 

1. Pre-Authorization Made Easy: When needed, Obtain prior authorization for services. Taking this step early can prevent payment delays.
2. Use Data to Your Advantage – Track trends in payment and denial rates. Understanding where the issues are can help you fix them before they become more significant problems.
3. Set Clear Payment Policies – Let residents and their families know what to expect regarding costs, insurance coverage, and co-pays. Clear communication makes billing less stressful for everyone.
4. Don’t Ignore Denied Claims – When a claim is denied, don’t just move on. Have a system for quickly appealing those denials with the proper documentation to recover lost revenue.
5. Leverage Automation – Automation can speed up the claims process and reduce human errors. Look into tools that help automate repetitive tasks so your staff can focus on more complex issues.

Billing Medicare and Medicaid: Key Things to Keep in Mind 

• Know the Prospective Payment System (PPS): Medicare reimburses SNFs based on the services provided and the patient’s care needs. Make sure you’re familiar with how this works.
• Check Your Minimum Data Set (MDS): Accurate MDS assessments directly affect reimbursement rates, so be thorough when completing them.
• Consolidate Billing: To avoid duplicate claims, bill all services covered by Medicare Part A together.

Mistakes to Avoid in SNF Billing (h2)

• Missing Deadlines: Late submissions can cost you. Keep track of your timelines.
• Getting Patient Info Wrong: Small mistakes like incorrect patient info can lead to significant issues. Double-check everything.
• Ignoring Denied Claims: Denied claims shouldn’t be forgotten. Timely follow-ups are crucial.
• Not Verifying Insurance: Make sure insurance details are correct before submitting claims. If a patient’s coverage changes, catch it early.

Conclusion 

Running the billing side of a skilled nursing facility is an enormous task. It takes the right tools, ongoing training, and attention to detail. These best practices can reduce claim denials, improve revenue cycle management, and keep your SNF’s finances in good shape. Whether you handle billing internally or with outside help, the goal is always the same: accuracy, efficiency, and getting paid for the care you provide.