Revenue Cycle Management for Skilled Nursing Facilities

Stay up-to-date on skilled nursing regulations along with tips and tricks to improve your medical billing from the experts at MCA.

Medicare Coverage Rules Every SNF Administrator Should Know

Medicare coverage rules for skilled nursing facilities are not just a topic for billing specialists and compliance teams. They are operational knowledge that every SNF administrator needs because coverage decisions made at admission, or misunderstood during a resident's stay, create billing...

How SNF Coverage Determination Affects PDPM Reimbursement

Medicare coverage determination and PDPM reimbursement is discussed as separate topics in most SNF billing conversations. Coverage is treated as an admissions and eligibility function. PDPM is treated as a coding and MDS function. In practice, they are directly connected and errors in...

When Your SNF Biller Leaves: How to Protect Revenue Cycle Performance During a Billing Vacancy

When an SNF biller gives notice, the instinct is to treat it as a staffing problem. Post the job, cover the work in the interim, hire a replacement, train them up. It is a familiar sequence that feels manageable in the moment. What gets underestimated almost universally is how quickly a...

Medicare Prospective Payment System Under PDPM: The Five Components That Determine Your SNF Reimbursement Rate

The Medicare Prospective Payment System for skilled nursing facilities has undergone one fundamental transformation since its introduction the replacement of the Resource Utilization Groups model (RUG-IV) with the Patient-Driven Payment Model (PDPM) in October 2019. That transition changed...

Medicare Advantage and SNF Consolidated Billing: The Compliance Gap Most Facilities Don’t Know They Have

Medicare consolidated billing is one of the most foundational compliance requirements in skilled nursing facility operations. Under Medicare fee-for-service, the rule is well-understood: the SNF is responsible for billing all services provided to a Medicare Part A resident during a covered...

A Complete Reference to Medicare Hospice Billing Modifiers What Each One Means and When It Applies

Medicare hospice billing modifiers appear on physician and non-physician practitioner claims for services provided to patients enrolled in the Medicare Hospice Benefit. They signal specific circumstances about the provider's relationship to the hospice organization and the nature of the...