Written by For skilled nursing facilities, efficiency is not just a goal but a necessity to sustain the care quality and overall performance.
To sustain the performance and reputation of your facility, the care process is not enough. The financial aspects of your practice have equal parts to play.
However, in skilled nursing facility billing services, certain inefficiencies result in delays in payment, higher charge denials and thus, loss of revenue. Recognizing these situations as inefficiencies is the starting point to improving your revenue cycle as well as having sound operations.
This article will give you common pain points that need to be addressed in skilled nursing facilities and how collaborating with a SNF Billing company solves it.
Signs of Inefficiencies in SNF Billing Services
1. High claim denial rates
One of the biggest signs of inefficiency is the high claim denial rate. Here are some of the reasons for claim denials-
- Misdiagnosis of patient’s illness
- Misinterpretations in the coding and billing resultant from diverse regulations and guidelines
- Noncompliance with payers’ specifications
It is important to monitor denial rates on a frequent basis and then try to understand why such denials are being made.
2. High Accounts Receivable (AR) days
Do you observe AR days increasing than the benchmark which range from 30–40 days? In that case, factors such as poor follow-up on unpaid claims or delays in submission of claims may be showing.
3. Frequent coding errors
skilled nursing facilities naturally deal with complex billing codes, especially concerning Medicare and Medicaid. Incorrect coding not only results in claims being held up for reimbursement but also creates audits and penalties.
4. Lack of utilization of technology
If, for instance, you continue using an old version of software, or you do not even use software to automate your billing processes, you are likely to have serious issues with the efficiency of your billing processes. Contemporary facility billing solutions contain automated structures for enhanced operational flow.
5. Staff burnout
This is because billing inefficiencies are mainly a result of too much workload being assigned to the staff. When a team is handling several tasks without specialist skills, you are dealing with pitfalls and variabilities.
The Source of SNF Billing Discrepancies
- Lack of specialized knowledge: The skilled nursing facility billing needs a professional approach on the rates with states and federal laws which are dynamic.
- Inadequate documentation: Insufficient or wrong information in the patients’ files will cause tremendous delays in the processing of claims and increase the likelihood of claim rejections and denials.
- Poor denial management: Without a structured denial management system you can easily lose revenue.
- Absence of prior authorizations: Failing to obtain prior authorizations for services leads to claim denials and revenue loss.
Why Outsourcing Skilled Nursing Facility Billing Makes Sense?
- Domain expertise: An outsourced SNF billing company has specialized knowledge and skill set to carry out the administrative aspects related to nursing facilities.
- Efficient claim management: These companies have a team of expert professionals who have detailed knowledge of claim submission requirements which eliminates the chances of errors and improves first-pass clean claim rates.
- Cost-effective operations: While maintaining an in-house billing team in your skilled nursing facility is costly due to high labor wages and immense labor shortage; partnering with an outsourced medical billing company help you get rid of the overhead costs of infrastructure along with hiring, training and retaining employees.
- Focus on patient care: With a team of experts handling your tedious administrative tasks, your staff can focus on providing the utmost care for the patients.
Final Thoughts
Inefficiencies in your SNF billing services waste your precious time, money and human resources. It is important to identify such gaps for organizations to enjoy financial stability as well as proper running of their activities. In this way, by sending your billing process to a skilled nursing facility billing company, you can not only work with those weaknesses but also call new opportunities.
Choose a reputable revenue cycle management organization who can streamline your billing and coding processes with industry best practices and advanced technologies as per the industry standards.
With a reliable billing partner, you will never lose personal touch within the care process which in the long run not only sustains your reputation but also revenue.