Nursing homes provide long-term care through support with everyday activities, rehabilitation and medication administration.
The space is already grappled with staffing challenges and the frequent changes in nursing home billing and coding regulations and guidelines, make it difficult for the providers to sustain and optimize the reimbursements.
This blog will give you a brief idea about the intricacies of nursing home billing and coding processes to help you navigate through the complex maze of healthcare revenue cycle management.
Nursing Home Billing Statements
Most nursing homes bill the resident (or the resident's legal representative) on a monthly basis for the care they provide.
The details of your contract should specify how often bills are sent. The cost of supplementary services may be included in the nursing home bill in addition to the standard rates.
It's critical to understand the distinction. The complexity of care, the extent of services, the kind of room (private or semi-private), and other facilities will all have an impact on the nursing home billing rate.
The timely submission of these monthly claims is required after a resident's:
- Release
- The end of their benefit tenure
- Drop of the nursing home facility
In compliance with CMS regulations, the claims processing system must suitably track the benefit length when a patient's or resident's benefits are depleted.
The billing cycle for nursing homes and the duration of all services rendered to residents should be as specific as feasible.
A prorated payment for the month of admission (the number of days spent at the facility multiplied by the room and board rate) should appear on the first billing statement, assuming the resident did not check into the healthcare center on the first day of the billing cycle.
In addition, a "pre-bill" for the following month's expenses is often included in nursing home invoices; once more, many states charge a tax on the entire bill amount. After deducting any Medicare/Medicaid, health insurance, and/or long-term care insurance payments, the resident will owe the remaining sum shown in these numbers.
Tips for Effective Nursing Home Billing
Accounting staff and administrators of skilled nursing facilities need to make sure that their nursing home billing process is proper in order to avoid fines.
For long-term care facilities, the HHS offers billing guidance that includes the following points to remember:
- Use days do not include a patient's or resident's date of discharge, death, or the beginning of a Leave of Absence (LOA).
- If a Medicare beneficiary is released from treatment and returns before midnight on the same day, Medicare does not take that discharge into account.
- The assessment that is submitted to and approved by the state in which the long-term care facility is situated must match the Health Insurance Prospective Payment System (HIPPS) rate number that appears on a claim.
Outsourcing: The Time-Honored but Best Solution Ever!
Nursing homes can increase revenue by optimizing and enhancing the billing process for skilled nursing facilities.
Nursing home administrators can make sure their facilities can optimize payments for the services they provide when they are aware of and appropriately apply their nursing home billing criteria.
This can be a laborious and complex process that requires familiarity with insurance plans, payment methods, and billing rules and regulations. By outsourcing revenue cycle management services to a reliable organization, these problems can be resolved.
Additionally, it enables nursing homes to maintain adherence to standards that are always changing, freeing up staff members to concentrate on patient care. If skilled care homes want to improve their billing procedures and general financial health, they should give outsourcing significant consideration.
No comments:
Post a Comment