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 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...

Long-Term Care Revenue Cycle Management: A Complete Guide for LTC Operators

Long-term care revenue cycle management is the end-to-end process of managing the financial operations of a long-term care facility from the first contact with a prospective resident through the final payment for their last day of care. For LTC operators, the revenue cycle is more complex...

How to Identify Hospice Claims: A Billing Reference for Providers and Payers

Identifying a hospice claim correctly is the starting point for managing billing coordination, Medicare coverage limitations, and compliance obligations correctly in a hospice setting. For hospice providers, understanding the specific coding elements that identify a claim as a hospice claim...

MDS 3.0 Assessments Explained: What They Are, Why They Matter, and How They Drive SNF Reimbursement

The Minimum Data Set 3.0 is the federally mandated clinical assessment tool used in Medicare and Medicaid-certified skilled nursing facilities. Every resident admitted to a certified SNF must be assessed using the MDS 3.0 at defined intervals, and the data captured in those assessments drives...