Skilled nursing facility billing teams bill & code for various medical services. This is already a complicated task. But due to constantly changing guidelines, it becomes difficult to keep up with updates.

This increases errors in the billing process. Because of this, SNFs have to spend a lot of time, money, and effort. Most of these resources, during this process, are spent on managing and resubmitting denied claims.

Speech therapy and rehabilitation therapy are two very common services provided at SNFs. They are also incredibly difficult to code for. Also, these healthcare services require prior authorization.

Additionally, SNFs also provide assisted living and other specialized medical services. To provide these services, they rely on healthcare professionals like speech and physical therapists.

Skilled nursing facility billing errors and claim denials prevent these providers from paying these professionals on time. It also affects their ability to recover sufficient payments to cover their expenses.

Recently, the CAQH highlighted that admin costs associated with claim denials amount to over $31 billion each year.

Therefore, to help operators of skilled nursing facilities reduce claim denials and their associated costs, we will discuss how improving SNF billing accuracy can reduce denials.

How Higher Accuracy in Skilled Nursing Facility Billing Can Reduce Denials

A higher billing accuracy can cut down claim denials significantly. When billing accuracy goes up, errors come down. Fewer errors equal fewer claim denials.

Skilled nursing facility billing accuracy can impact claim denials in several ways. It can reduce indirect costs associated with denial management. This makes the entire process more cost-efficient.

Here are a few ways how better SNF billing accuracy reduces claim denials:

 1) Higher first-pass rate:

The first-pass rate is calculated by dividing the number of claims that get cleared at the first attempt by the total number of submitted claims. A higher FPR indicates a higher number of claims getting approved at the first go.

2) Fewer errors get submitted with the claim:

When a skilled nursing facility’s billing accuracy is high, a good amount of the submitted claims are free of billing & coding errors. Having a high clean claim percentage helps providers avoid various revenue cycle issues.

3) Regulatory compliance:

Medical providers have to work with a lot of sensitive healthcare information. Besides data sensitivity, there are other regulatory requirements that take up a lot of time. They also increase operational costs. By maintaining a high billing accuracy, providers can ensure compliance and reduction in claim denials. It can also help avoid fines, penalties, and investigations by regulators.

Read More:

A Complete Guide on Skilled Nursing Facility Billing

Mastering Skilled Nursing Facility billing is complex. Consider outsourcing to Sunknowledge for reliable support. Proven expertise awaits. click to learn more.

To learn more about how you can improve the accuracy of your skilled nursing facility billing operations or to find out more about our RCM best practices, please contact Sunknowledge Services Inc., a revenue cycle management company serving US healthcare providers and payers since 2007.


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