Nursing home billing is complex and needs a specialists care. Nursing home billing is typically characterized by the uncertainty of services covered by Medicare. Another striking aspect of nursing home billing is the issues surrounding the nursing home accounts receivables. The in-house staff of the nursing homes put a lot of effort in handling the billing activities. However, a lot of factors including their round-the-clock patient care responsibilities do not really help them to focus on the nursing home billing services alone. This indeed affects the quality of bill handling and results in rising cases of rejections and denials. As a better alternative, nursing homes have found the professional nursing home billing services much more cost-effective and equipped to serve the purpose.

Medicare Nursing Home Billing Services: Dealing with Accounts Receivables
For any nursing home facility, the accounts receivable comprise the major part of the operational concerns. Few nursing home/skilled nursing facility (SNF) can afford skilled people among their in-house staffs who can expertly handle account receivables. With tremendous pressure on them to handle both the billing responsibilities as well as patient-care duties, it becomes difficult for the practice to chalk out a good accounts receivables management policy. This affects the revenue health of the practice in the most negative way.

One of the few glaring reasons these nursing home account receivables / bad debts do not result in a timely collection is the absence or limitation of timely follow-up on outstanding claims, whether it regards to Medicare/Medicaid pending or private pay. Account receivables dating back as long as 4 to 5 years or more are also not surprising.

One area where the professional nursing home billing services score over the internal staffs is the ability to analyze the accounts receivables. According to industry surveys, an average of 14% of all submitted claims is denied or need resubmission, appeal, or written off by providers. The optimistic anticipation is that 50% to 70% of denied claims have a high chance of being recovered. This can be well-achieved through an aggressive follow-up strategy through continuous communication with the insurance company. This can be done on all accounts of the ageing bucket irrespective of how old the debt is. This amount of research and analytics can be offered by mostly professional billing companies with highly skilled resources and use of latest technology and state-of-the-art infrastructure.

The other area that needs an expert’s intervention is the consolidated billing under the Prospective Payment System (PPS), etc. Consolidated billing involves bundled payment, which is the reimbursement of healthcare providers based on the expected costs for clinically-defined separate episodes of care. SNFs need to bill the bundled services for the Part A Medicare Administrative Contractor (MAC) in a consolidated bill for services like:
• Semi-private/shared room
• Meals
• Skilled nursing care
• Physical and occupational therapy if required
• Speech-language pathology services if required
• Medical social services
• Medications
• Medical supplies and equipment used in the facility
• Ambulance transportation required in case of urgency to the nearest facility provider
• Dietary counselling

A competent nursing home billing service will oversee the entire denial management system of a care facility sometimes providing a comprehensive Revenue Cycle Management solution.

Ronnie Hastings
Director of Business Development at Sunknowledge
Phone: +1 646-661-7853
Fax: +1 212-924-3473
[email protected]