Essential Medicare Updates for Nursing Home Medical Billing that You Must Know

 

We all know the fact that the Medicare costs are changed every financial year and you must stay on top of these cost-related updates to ensure a perfect nursing home medical billing system. You should stay alert to the new changes that will be updated by Medicare on 1st January of next year. The reality is that Medicate Part B is going down and Part A will go up, so you must ensure that your nursing home medical billing is in per with the new changes that are coming into effect in 2025. 

You need to know the Medicare Part B premium for your patients in 2025 to keep your billing accurate. 

Medicare Part B premium for 2025:  

Your patients need to standard monthly Medicare Part B premium of $185.00 from 2025 which is $10.30 extra from the current financial year, ie, 2024. Your patient’s Medicare Part B will cover your visit and outpatient care. The more your patient earns, the more premium they have to pay. Your patient needs to pay extra if they earn more than $103,000. The highest amount that your patient may have to pay is almost $505 per month for Part B. You must know about this information, especially when you are handling nursing home medical billing.  

Your patients have to pay other costs like deductibles and coinsurance if they have Medicare Part A and B. Your patient needs to pay the deductible amount of $257 from 2025.  

Now, you must know about the critical changes in CMS rules and guidelines 

Changes in billing rules in 2025:  

If you're curious about the changes, the IPPS now has a new way to classify the severity of certain diagnosis codes for homelessness. This is to ensure that people experiencing homelessness get the care and support they need! 

Starting October 1, 2024, CMS will stop checking for mismatches between a patient’s sex and their diagnosis or procedure. But don’t worry—IMO Health will still do these checks for ICD-10-CM codes to make sure everything matches correctly for you! 

The Patient Safety Structural Measure is all about keeping your patients safe. It’s a new way to see if nursing homes have the right setup, culture, and leaders who truly care about patient safety. 

The goal of this new model is to see if paying one price for all care in an episode (called bundled payment) can save money while still giving your patients good care. Some hospitals and nursing homes will follow the Transforming Episode Accountability Model (TEAM) for certain Medicare patients. It helps make sure your patients get the best care without wasting their money! 

You must be prepared for the changes in Medicare costs and make sure your nursing home medical billing system is up-to-date for 2025. You should always stay on top of all the updates as the Medicare Part B and Part A costs are increasing. Make sure your nursing home billing is prepared to handle the new costs and billing rules so your patients get the right care and you stay on track financially. You can always make sure everything runs smoothly and your patients receive the best care possible by partnering up with a professional nursing home medical billing company. 

Initiating a Cohesive Approach to Meet DME Billing Guidelines

A major chunk of DME suppliers are currently under huge stress. Making sure that all your pre and post DME billing priorities are in place will eventually depend on how you plan ahead and stay ahead of the competition.  

• Also, it is going to be pertinent to lower down all your operational expenses and gain a definitive competitive advantage by working with someone that works as a dedicated operational extension.  

• The main problem always reside with any pre DME billing measures.  

• You must create best in class facilities, implement quality EMR systems and automate with experienced billers that can help you have a clean first pass rate of claims submission.  

• That is where a dominant vendor with extensive knowledge of the latest claims adjudication demands can lend a composite support.  

How to choose your reliable DME billing company 

• The mainstay of any DME billing and coding company is in understanding how to lower down on your operational expenses.  

• Choosing a dedicated vendor that can help you streamline all your front and back end efforts will be something that will help in streamlining all your DME revenue cycle management efforts.  

• The right partner will be making use of the available resources and will be implementing the desired checks and balances for cleaner collections.  

• The right vendor has an understanding on how to engage with your audience by a careful assessment of what is available and that is going to set the difference in your DME billing demands in the long run.  

Also, it will be an excellent opportunity to know whom to trust at these trying times when you are stuck in finding a genuine balance that can help you meet the latest Medicare part B demands and help you achieve a transparent competitive presence in the entire market place.  

Knowing whom to rely upon will actually help you choose the ideal alternative and make the correct choice with your DME billing partner.  

One of the key areas of concern will be to know how to amplify growth by knowing their client references. 

The ideal ones will be able to justify your revenue potential and help you focus more on your patients by performing all the specific activities in checking of eligibilities, prior authorization, order entry/ confirmation, medical coding, claims submission, denial management, accounts receivable recovery and payment posting.  

Also, knowing what will be their modes of communication will be extremely critical. You must be investing quality measures that will streamline all your pre and post DME billing demands and help you achieve a competitive presence in the best possible manner. The right vendor will be working as a complete extension and will be providing customized reporting support at next door rates and that will have a huge impact on your everyday operational expenses in the long run. That will help you in knowing what it takes to define ROI and achieve a definitive competitive presence.  

Achieve dominance with Sun knowledge Inc 

Over the last decade, we have transformed DME billing demands with our exclusive support. Our team extends cutting edge support that elevates your practice management priorities. Our team excels in working across numerous practice management systems with complete authority. Hire us at just $7 per hour and make a complete change in the way you handle your DME billing and coding demands.  

How to improve home health prior authorization process

To determine the eligibilities and depending on the payer, a home health agency (HHA) might need a prior authorization. To provide a service for a specific duration and a type of service, home health prior authorization will be preventing any unnecessary procedures.  

• In fact with the rise in the number of HHA’s around which is almost 50% from 2010, it is evident that the burden of home health prior authorization has only increased over time.  
• The eligibility requirements of home healthcare practices (HHP) and its prior authorization details vary in greater details.  
• Home healthcare practices need prior authorization for skilled, unskilled and additional services.  
• An NAHC study clearly says that 96% of home health agencies face some sort of prior authorization delays.  
• Also, a lengthy process with application and the following consequences make it quite difficult for your in house resources.  

In fact it is one of the main reasons why rejections have doubled between 2016 and 2020. Almost 45% report that limitations with staffing are causing huge delay in paperwork jobs with home health prior authorization.  

Significance of a quality home health prior authorization services company 

Thus, it is pertinent to choose someone with intuitive understanding of the latest practices in home health prior authorization and how it can transform your ROI possibilities once and for all.  

• Creating a strong system that can help you implement checks and balances for cleaner collections will be the key story ahead.  
• It all boils down to opting for a genuine partner that can help you elevate your prior authorization process and assist you in connecting all your gaps in front and back end home health prior authorization demands.  
• The biggest difference is in knowing whom to trust and set the ideal benchmark and upgrade the collection priorities by working with someone that can serve as a dedicated arm of existing operations. But the problem lies in finding a guide!  

Also it can turn out to be confusing task and choosing a disciplined partner to manage everything for you right from start to finish. At the end, what you want is focusing on your patients while your home health prior authorization services company takes care of all the other aspects. Also, finding a tangible roadmap to lower down all your everyday practice management demands will be the key area of concern for many.  

Believe in Sun Knowledge Inc‘s extensive action plan 

Over the last fifteen years, we have been a trusted partner for some of the top home healthcare agencies with great references. We are unique as we can serve with great confidence and upgrade all your front and back end demands with home health prior authorization by helping you initiate the PA request, checking the patient eligibility, working on with the physician office, contacting payer and knowing the outcome, updating the auth outcome in the PM billing system.  

Moreover, our team will be guaranteeing 100% PA submission on the same day and that too with 99.99% accuracy. The best part, our services are placed at just $7 per hour and that too without any additional charges. Speak to our team and come to know how we set the benchmark and help you achieve the dividends by working as your ideal extension.