SNF billing (skilled nursing facility billing) is the process of submitting claims to Medicare, Medicaid, managed care plans, and private payers for the healthcare services provided to residents in a skilled nursing facility. It includes coding diagnoses on the MDS assessment, generating HIPPS codes under the PDPM payment model, completing UB-04 claim forms, managing authorizations, […]
Outsourcing SNF billing means hiring an external team to handle some or all of your skilled nursing facility’s billing and collections — Medicare, Medicaid, managed care, or all of the above. It’s not the right move for every facility, but for organizations struggling with denials, aging A/R, staff turnover, or compliance concerns, outsourcing can stabilize […]
Medicaid pending status means a nursing home resident has applied for Medicaid benefits but hasn’t yet received an approval or denial from the state. This period — which can last anywhere from 30 days to several months, depending on the state — creates a billing gap in which the facility is providing care but may […]
SNF billing guidelines are the rules and procedures that govern how skilled nursing facilities submit claims to Medicare, Medicaid, and other payers. These guidelines cover everything from admission documentation and MDS timing to UB-04 form completion, condition codes, and filing deadlines. Getting them right means getting paid on time; getting them wrong means denials, delayed […]
PDPM (Patient Driven Payment Model) is the Medicare reimbursement system that determines how much your skilled nursing facility gets paid for each Part A resident. Implemented in October 2019, PDPM replaced the old RUG-IV system by shifting payment away from therapy volume and toward patient characteristics — diagnoses, functional status, and clinical complexity. In 2026, […]
In our previous blog “PDPM Reimbursement Part 1”, we reviewed the clinical changes, the MDS Assessment Changes and their relation to generating the Patient Driven Payment Model (PDPM) HIPPS Code. In this blog we will be exploring and explaining the complexity of the new HIPPS Codes Components and the tables provided by CMS in the […]
PDPM is coming October 1, 2019, what does this mean to Skilled Nursing Facilities? Are you prepared and ready for the changes that are involved? This proposed change to how reimbursement for Skilled Nursing Facility care is determined is very complicated and will possibly reference topics and industry verbiage you may not be familiar with. […]
We don’t have to tell you that billing and collecting for skilled nursing facilities is complex. But it doesn’t have to be. We are committed to making this process as easy as possible for your organization, so you can get back to caring for your residents. That starts with our website. We’ve created our new […]
Though it may seem obvious that the most important factor in how a Business Office performs is the Business Office Manager. In Part 2 of our “Red Flag” Blog Series we consider this very critical staff member and the indicators that could be telling you might need to consider taking action. In every Skilled Nursing […]
The Business Office is critical to the operation and survival of every Skilled Nursing Facility. The Business Office is usually the least understood of all the major departments, as well as having the lowest level of supervision. In our two-part “Red Flags” blog series, we will be discussing areas and indicators that can be monitored […]
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.
