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What are the Challenges of Skilled Nursing Facility Billing?

Producing an SNF claim under combined billing requires knowledge of the code and what Medicare  A (a policy for paying certain hospital and medical expenses for elderly persons qualifying under the plan) covers and does not cover. 

If something is not covered by Medicare A, it can be covered by Medicare B. The SNF(skilled nursing facility) must identify these and calculate them separately. Today, many medical professionals use nursing home invoice softwares for ease.

In billing, daily allowance means a fixed amount that CMS pays to SNF under Medicare A, for which SNSF pays contracted care providers for their services.

1) SNF must now submit its application as part of the combined billing within the Prospective Payment System (PPS) framework.

2) SNF is paid daily by Medicare A.

Treatment facilities are facing the following problems:

1) Inaccuracies in the code applied to lead to denial of claims.

2) Inadequate knowledge of Medicare items A and B.

3) Fixed payments for services that do not adequately cover nursing home costs – given a certain cost elasticity in the range of services offered by facilities, which are often not covered by fixed rates.

The two scenarios above expose the care facility to two types of revenue outflows: one is through rejected applications; another is underpayment for services.

In addition, it is often difficult to determine whether a patient requires nursing home services and spends a lot of time on non-medical activities.

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