A business office review is a comprehensive assessment of your skilled nursing facility’s billing operations — processes, staffing, systems, and financial outcomes. It identifies where money is being lost, where compliance gaps exist, and where operational improvements can increase revenue without adding a single resident. If you’re not sure whether your Business Office is running as well as it should be, these five signs will tell you.
Pull your aging report. Look at the 90+ column. Is it larger than it was 3 months ago? 6 months ago? If claims are stacking up past 90 days across multiple payers, that’s not a payer problem — that’s a process problem. It means claims aren’t being worked, denials aren’t being appealed, and follow-up isn’t happening consistently.
A healthy SNF should have the vast majority of its A/R collected within 30-60 days. If your 90+ column represents more than 15-20% of total A/R, something is broken.
If you asked your BOM right now, “What percentage of our Medicare claims get denied on first submission?” and they couldn’t answer, that’s a problem. If they can answer and the number is above 5%, that’s also a problem. And if denied claims aren’t being tracked — reason, payer, amount, appeal status — then you have no way to identify patterns and fix root causes.
In many facilities, the BOM handles Medicare billing, Medicaid billing, managed care billing, private pay collections, admission paperwork, census management, and reporting to the administrator. That’s too much for one person. When one person does everything, nothing gets the attention it needs. Claims fall through cracks. Follow-up gets delayed. Denials don’t get appealed.
If your BOM hasn’t taken a vacation in years because “everything would fall apart” — that’s a sign your office needs structural help, not just harder work.
Every time a BOM or billing clerk leaves, institutional knowledge walks out the door. New hires take 3-6 months to get fully productive in SNF billing. During that ramp-up period, claims get missed, processes get skipped, and revenue dips. If you’ve had multiple turnovers in the past year or two, there’s almost certainly uncollected revenue sitting in your aging that the new team doesn’t even know about.
Are you billing Medicare Secondary Payer claims when applicable? Are you submitting Benefit Exhaust and No Pay claims monthly? Are you billing managed care informational claims with Condition Code 04? Are you capturing all Part B services for non-Part A residents? If the answer to any of these is “I’m not sure” or “probably not,” a review will tell you exactly what’s being missed — and how much revenue you’re leaving on the table.
A business office review isn’t about finding fault with your team. It’s about finding money. Every facility we’ve reviewed has had at least one significant revenue opportunity that the internal team simply didn’t have the bandwidth or perspective to see. Sometimes it’s a process gap. Sometimes it’s a training issue. Sometimes it’s a payer source that nobody is billing correctly.
SNF Solutions offers free initial A/R aging reviews. If what we find warrants a deeper dive, we’ll tell you. If your office is running well, we’ll tell you that too.
Contact us for a free A/R aging review or call 407-977-8878.
— Nicole
Chances are that you’re leaving revenue on the table. This quick resource guide will help ensure that your office is getting the most from your existing business so you can maximize your revenue without adding a single resident.
