SNF Billing 101: Navigating Common Issues

The billing of SNF (skilled nursing facility) can be complex and error-prone. However, being armed with the right knowledge and processes can make a major difference. This guide breaks down some of the most common SNF billing problems and explains helpful strategies and tips for streamlining processes.

Complications With Billing Codes

Errors or outdated codes can undermine the billing process. Some complications include:

1. Incorrect code selection: Selecting codes that do not accurately represent the provided services or conditions can disrupt the billing process, leading to claim denials or payment delays.
2. Outdated code usage: Using codes that are no longer applicable due to changed ICD-10 guidelines or updates can result in billing inaccuracies.
3. Manual errors in code input: Typos or numerical mistakes during code input may lead to reimbursement challenges. 

Poor Documentation

One of the most frequent issues with SNF billing is incomplete or inaccurate documentation. This leads to denied claims and revenue loss. Some major documentation pitfalls include:

• Lack of confirmation of medical necessity
• Inadequate support for medical documentation

Ensuring documentation is detailed, timely, and accurate is essential. Utilize templates to prompt comprehensive note-taking. Thorough documentation better supports claims and facilitates appropriate payment.

Failed Eligibility or Missed Coverage Changes

SNF billing faces the challenge of failed eligibility or missed benefit coverage changes, which can significantly impact reimbursement and revenue. Some key issues include:

• Incomplete verification of eligibility: Failing to thoroughly verify patient eligibility before providing services can lead to claim denials or underpayment.
• Missed updates in benefit coverage: Changes in patients’ insurance plans or coverage details may go unnoticed, resulting in billing inaccuracies and revenue loss.
• Lack of proactive tracking: SNFs risk overlooking important updates that affect billing and reimbursement processes without a system to track and manage benefit coverage changes.

Untimely Billing

SNF claims have strict billing timelines. However, many facilities struggle to meet these windows due to understaffing or inefficient processes.

• Medicare SNF claims must be filed within 1 year of the discharge date
• Other payers often require claims to be submitted within 90-180 days after discharge

To address this issue, create workflows to enable billing soon after discharge. 

How To Manage Denials

The issues listed above often lead to claim denials from the payers. Let’s explore the key aspects of SNF claim denial management: :

• Rigorously assess the main causes for denials Categorize reasons (lack of medical necessity documentation, incorrect coding, failed eligibility, etc.) to prevent future mistake and improve billing accuracy 
• Allow time for careful claim review pre-submission vs rushing. Double-check the codes carefully.
• Incorporate denial management modules in billing systems. Automate repetitive manual  tasks like invalid code checking. 

With robust denial management infrastructure nursing homes can systematically prevent, diagnose, appeal and learn from denied claims. This reduces revenue leakage and improves cash flow.

Complex Patient Classification

Misclassifying a patient’s designated groups and categories can significantly impact reimbursement. Common classification issues arise around areas like:

• Therapy minute thresholds
• Documenting daily skilled needs
• Interrupted stay determinations

Additional Billing Considerations

In addition to the challenges outlined above, there are several other factors that require careful consideration in SNF billing:

Compliance with Evolving Regulations

Regulations related to SNF billing and reimbursement frequently change. Staying updated requires constant attention, and non-compliance can result in payment denials, audits, or penalties for violations.

Regularly monitor updates from CMS. Subscribe to email updates from associations like AHCA or attend webinars. 

Staff Turnover Disruptions

Frequent staff departures in key revenue cycle roles like coders, billers, A/R supervisors can severely impact productivity. New hires require training and time to become proficient.

Cross-train existing staff to fill gaps when turnover happens. Create thorough procedure manuals and training programs to speed up the onboarding of replacements. Consider billing outstaffing for added support.

Facilities can improve their processes by identifying common billing challenges in SNFs and avoiding revenue loss. Minor workflow and documentation adjustments, staff education, and utilization of technology tools can offer significant benefits. With a strong foundation, facilities can feel empowered to manage billing and revenue cycles.