Operating a skilled nursing facility requires a delicate balancing of patient care, staffing, handling constant regulation changes, and financial resources that depend on impeccable billing. Here comes into play the fact that few billings are as tough as that of the Medicare Part A post-acute admissions billing. That is precisely why almost all the managers use a professional SNF billing service today. But not all billing services are equal. The wrong choice can bring late payments, violations of regulations, and months of corrections. And here is where the following ten questions come in handy. They will help you separate true professionals from those who promise immediate results only.
Why the Hiring Decision Carries So Much Weight
Skilled nursing facility billing is much more complicated compared to conventional medical billing. The same facility could bill Medicare Part A, Medicare Part B, Medicaid, Medicare Advantage Programs, and other insurance companies, which have varying procedures and policies. In addition, consolidated billing, the three-day qualified hospitalization, and 100 days' benefit period all increase the complexity. Outsourcing of SNF billing has therefore become quite common as operators seek to minimize mistakes and give their in-house staff more time to focus on taking care of residents.
1. How Much Long-Term and Post-Acute Care Experience Does the SNF Billing Company Have?
Billing experience in general will not necessarily apply here. An experienced SNF billing company should be able to explain the kind of facilities they serve, facility size, the payers, and which states they work in. It may also be worthwhile to ask for referrals from operators that are like the facility you’re working with, along with how long on average their clients work with them.
2. How Does the Team Handle PDPM and MDS Accuracy?
From the starting of October 2019, RUG-IV model is no longer in use under Medicare Part A reimbursement; instead PDPM model has taken the center stage. The basis for reimbursements is based on clinical data collected through the MDS 3.0 assessment, not therapy minutes. A proficient billing department will be aware of the connection between PT, OT, SLP, nursing and non-therapy ancillary components to produce the correct HIPPS code. It is wise to find out how the vendor processes assessment reference date and how does coordination take place with the MDS coordinator before claims submission.
3. What Is Included in the Scope of Services?
An SNF billing company stating that they offer full revenue cycle management, means that they take care of everything including eligibility verification, prior authorization management, filing of claims, denial and A/R management and so on. However, while certain vendors may handle all or parts of the process, it is essential that it be clearly stated in writing. Furthermore, practices must enquire whether or not the following processes fall within the vendor’s scope of services: Medicare Part B Therapy billing, Medicaid Pending cases, Patient Liability cases, and Private Pay cases.
4. How Does the Company Protect Compliance and Data Security?
The skilled nursing claims often receive careful analysis from the auditors, including the Medicare Administrative Contractors and the Recovery Audit Contractors. A good SNF billing service firm would have a HIPAA Business Associate Agreement signed, use an encryption program with access controls based on roles, and train the staff on current guidelines released by the OIG. It is important to ask the SNF billing service firm about its readiness for the audit process.
5. Which Performance Metrics Does the SNF Billing Company Follow and Promise?
Numbers talk louder than words. Some useful benchmarks are clean claims ratio, first pass acceptance ratio, denial ratio, net collections ratio, and days in accounts receivable. Respectable companies will give you their benchmarks and some sample reports without hesitation. It is better to raise a red flag for companies that are not open to talking about benchmarking.
6. Can the Technology Integrate With the Facility's EHR?
Good data flow ensures no data redundancy and errors. The facility must find out if the vendor operates with their electronic health record system like PointClickCare or MatrixCare and how claims are sent to the provider. Electronic claims in 837I format, electronic remittance advice in 835 format, and a reliable clearinghouse make up good workflow nowadays. Dashboards in real time are an additional option.
7. How Does the SNF Billing Company Manage Medicare Advantage and Medicaid Managed Care?
In recent years guidelines regarding payer mix have evolved tremendously. While Medicare advantage plans vastly necessitate prior authorizations, strict reviews and rely on clinical updates to accordingly change their plans, Medicaid has its own timing and rules. A professional billing team ensures that all authorization days are accounted for, appeals any denied authorizations with proper documentation, and follows up on all pending authorizations. Otherwise, billable days become write-off days.
8. What Does Reporting and Communication Look Like?
The more there is transparency, the more trust is being created. There should be an investigation into who the designated account manager is, how often reports are delivered, and the time taken to respond to queries. Financial reports for the month, aging reports, and denials trends give all the necessary information to make decisions. The need for an escalation process is also just as important.
9. How Is Pricing Structured?
Most agreements happen based on a percentage of revenue, although flat fees may also be utilized. Both are fine, but hidden costs make problems. Good questions to ask to the SNF billing outsourcing services would be whether there are any fees for setup, clearinghouse, or reporting. Similarly asking about the duration of the agreement and the method of termination is equally crucial. Ownership of data is also critical, because a center should have access to its billing data at all times.
10. What Does the Transition Process Look Like?
Changing vendors may seem daunting especially when there are pending open claims. It is good practice for an efficient SNF billing company to offer a well-planned onboarding process that includes timeline, personnel involved, and process for dealing with the accounts receivable balance of your facility. You should also find out how they train their personnel and deal with personnel turnover.
Final Thoughts
Selecting an SNF billing company has nothing to do with selecting the least expensive one but is all about working with someone who understands the complexities of skilled nursing facilities. Here are ten questions that will give you a good start on how to evaluate the vendors and build relations with them to help you stay financially stable.
For those who are ready to take care of their revenue cycle, the assistance of a professional vendor who provides skilled nursing facility billing services will be beneficial.
