SKILLED NURSING FACILITY BILLING

Looking for the best Skilled Nursing Facility(SNF) billing companies? BillingFreedom allows nursing staff to focus on patient care with peace of mind

Skilled Nursing Facility Billing2022-05-17T15:50:24+00:00
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Introduction

As compared to the mid-twentieth century, nurses today have much greater responsibilities and enjoy an increasingly collaborative relationship with physicians. Nurses also play a key role in the healthcare industry by providing a vital link between doctors and patients.

With the help of licensed nurses, therapists, speech pathologists, and audiologists, skilled nursing facilities provide rehabilitation and medically-necessary services.

To help SNF managers, we have gone a step further and briefly explained skilled nursing facility billing guidelines as well as billing codes.

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Skilled Nursing Facility Billing

Looking for the best Skilled Nursing Facility(SNF) billing companies? Nurses are the backbone of the healthcare system as the entire medical industry is being managed with their help. BillingFreedom assists SNFs by providing high-quality and smooth medical billing, credentialing, front desk management, AR management, and RCM services. With the goal to maximize collections, BillingFreedom allows nursing staff to focus on patient care with peace of mind.

Skilled Nursing Facility Billing Guidelines

After the Balance Budget Act came into effect, reimbursement for care services received in a skilled nursing facility are subject to an increasing number of regulatory restrictions. In order to reduce potential fraud such as double billing by providers, SNFs currently bill medicare under the Prospective Payment System, just like the inpatient facilities get reimbursed for medically necessary care. This is referred to as skilled nursing consolidated billing. Let’s take a quick look at Skilled Nursing Facility consolidated billing.

SNF Consolidated Billing

In 1997, The US Congress mandated that payment for the majority of services provided during an SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. These bundled services had to be billed by Skilled Nursing Facilities in a consolidated bill. In short, entities that provide services in an SNF stay cannot bill separately for these services.

However, only a limited number of care services are specifically excluded from consolidated billing, and separately payable.

For Medicare beneficiaries in a covered Part A:

  1. Physician's professional services
  2. Certain dialysis-related services
  3. Certain ambulance services
  4. Erythropoietin for certain dialysis patients
  5. Certain chemotherapy drugs
  6. Certain chemotherapy administration services
  7. Radioisotope services
  8. Customized prosthetic devices

For Medicare beneficiaries in a non-covered stay:

For non-covered stay, only therapy services are subject to consolidated billing. All other covered services provided by Skilled Nursing Facilities for these beneficiaries can be separately billed.

Submitting SNF claims as part of consolidated billing requires a thorough understanding of medical codes and what is covered by Medicare A and what’s not. We have listed skilled nursing facility billing codes below for your reference.

Skilled Nursing Facility Billing Codes

99304:Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

  1. A detailed or comprehensive history
  2. A detailed or comprehensive examination
  3. Medical decision making of low complexity

Typically, 25 minutes are spent.

99305: Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

  1. A comprehensive history
  2. A comprehensive examination
  3. Medical decision making of moderate complexity

Typically, 35 minutes are spent.

99306: Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

  1. A comprehensive history
  2. A comprehensive examination
  3. Medical decision making of high complexity

Typically, 45 minutes are spent.

99307: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

  1. A problem focused interval history
  2. A problem focused examination
  3. Straightforward medical decision making

Typically, 10 minutes are spent.

99308: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

  1. An expanded problem focused interval history
  2. An expanded problem focused examination
  3. Medical decision making of low complexity

Typically, 15 minutes are spent.

99309: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

  1. A detailed interval history
  2. A detailed examination
  3. Medical decision making of moderate complexity

Typically, 25 minutes are spent.

99310: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

  1. A comprehensive interval history
  2. A comprehensive examination
  3. Medical decision making of high complexity

Typically, 35 minutes are spent.

99315: Nursing facility discharge day management; Up to 30 minutes.

99316: Nursing facility discharge day management; Over 30 minutes.

99318: Evaluation and management (E/M) of a patient involving an annual nursing facility assessment visit on the required schedule, that requires the following three components:

  1. A detailed interval history
  2. A comprehensive examination
  3. Medical decision making of low to moderate complexity

Typically, 30 minutes are spent.

You can read more about nursing facility medical billing codes at CMS.GOV.

Why BillingFreedom

Time is of the essence for healthcare professionals working in SNFs, to be bothered with medical billing and other back-office chores. SNF managers would need to spend precious work hours supervising billing departments, which can leave them pressed for time. Nursing facility managers can have peace of mind with our dependable SNF billing and revenue cycle management services. Moreover, BillingFreedom helps SNFs maximize their revenue, faster and more easily. Learn how, by giving us a call at (855) 415-3472.

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YOUR COMPLETE REVENUE CYCLE SUPPORT

Our approach takes RCM support services above and beyond. It is our mission to help you identify opportunities for both front- and back-end operational improvement, so that every dollar is captured, from patients to payers and everything in between.

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CREDENTIALING

We assist in credentialing healthcare providers with Government/Commercial Payers/Managed Care Plans and obtain CAQH quarterly re-attestations.

CONTRACT/PAYER NEGOTIATIONS

We’ll review existing payer/plan contracts, make appropriate recommendations for fee schedule/reimbursement terms, and track progress through the negotiation process.

BENEFITS VERIFICATION

We provide full phone, fax, and email support to outline patient benefits and coverage for specific medical procedures, before the point of service.

PRIOR AUTHORIZATION

We provide full phone, fax, and email support to obtain the prior approval necessary to acquire reimbursement for most non-emergency medical procedures.

INBOUND PATIENT CALL CENTER

Patients can use our call hotline to talk to our dedicated team about any billing inquiries they may have. We can also collect payment over the phone for additional support.

OUT OF NETWORK BILLING

We handle everything from sending claims and posting payments to negotiating the payment from the payer, and working with the payer to pay the negotiated amount.

WORKER’S COMPENSATION

We assist submission through specific payers designed for these types of claims.

ONE UNIFIED TEAM WORKING ACROSS MULTIPLE PLATFORMS

Our specialized team adjusts to your software strategy.

You can leverage our comprehensive medical billing support, regardless of whether you plan to transition to our robust, integrated PM/EHR platform or maintain your current vendor. Our technology-enabled solutions and flexible, consultative approach help you highlight areas of financial improvement.

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Choosing the Right Medical Billing Service: Key to Your Practice’s Success?

Choosing the right billing service is incredibly important. Our medical billers and coders can ensure an improvement in the efficiency of your practice by employing the best methods of optimally using your EMR, their exposure of various Practice Management Systems also provides greater collections for your practice. BillingFreedom experience in various EMR/EHR’s and certification in the medical billing processes will support your practice to grow steadily

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