SNF Billing Solutions can differ based on workflow approaches, including internal billing teams and outsourcing specialized experts. Choosing the right approach is important to ensure the effectiveness of the practitioners’ revenue cycle management.

Ensuring effective billing meaning claim formation and submission is necessary to ensure the financial health of skilled nursing facilities. Even the most minute errors in skilled nursing facility billing procedures like coding, prior authorizations and meeting documentation requirements can lead to claim delays and denials. This is why practitioners often rely on expert help to navigate such administrative burden while they focus on patient care.

However, practitioners these days are facing a major dilemma while acquiring this support; that is whether to hire internal teams or outsource to billing experts. Both these methods have unique sets of advantages and disadvantages, and having a deep awareness of the same is necessary for practitioners to be able to make sound decisions.

Understanding skilled nursing facility billing

Skilled nursing facility billing (SNF) refers to the submission of claims for post-acute care services in these specialized facilities. Simply put, it refers to billing for medical care, rehabilitation, and nursing services, for short-term or long-term recovery after hospital discharge. Some of the common challenges of such billing include:

• Frequent denial of claims.
• Complex payer specific demands; Medicare, Medicaid and other commercial payers have different regulatory requirements.
• Inaccurate documentation and coding.
• Managing consolidated billing (CB) requirements.

Navigating these challenges properly requires practitioners to acquire the right type of help.

What is in-house billing for a skilled nursing facility?

Having an in-house team means that the billing process for these special care facilities is taken care of by the facilities’ internal staff.  This means the internal team will manage all the steps in the billing process including insurance eligibility verification, prior authorization, coding, document submission, payment posting, follow-ups, and so on. Having an internal team can be advantageous for several reasons. For example:

• It will allow practitioners to have complete control or rather hands on oversight over the billing process.
• It also allows practitioners to provide staff training depending on changing regulatory requirements and instill accountability among staff.
• Lastly, it means that practitioners will have immediate access to the patients billing information.

However, there are also certain disadvantages to the same. Managing an internal team can be quite costly. As per industry reports, it can cost practitioners around 12.6%–14.7% of total collections. Secondly, without continuous training offered by the practitioners, these billers may fail to generate clean claims; meaning chances of errors in the claim submission can rise. This can be detrimental for practitioners’ cash flow.

What is outsourced skilled nursing facility billing?

Outsourcing billing happens when practitioners engage in contracts with third-party billing vendors to manage the facility’s revenue cycle management operations. These outsourced vendors often offer dedicated and trained billing personnel and software to help practitioners navigate the complexities of the process. Some of the advantages include:

• Reduced operational costs. Outsourced RCM solution companies typically reduce operational costs by 80%, and they charge as low as $7/hour for their SNF billing services.