As a qualified nursing care provider, billing and reimbursement are important considerations in ensuring quality patient care and adequate compensation. Skilled nursing organizations are at a tipping point with facilities operating on wafer-thin margins, not optimizing their current collections and now facing a $320 million cut proposal from Medicare in 2023.
Maximizing your revenue requires a coordinated team that understands the coding process and is committed to delivering optimal patient care. Maintaining consistent schedules and communication among team members can ensure that your facility is properly compensated for the high-quality care you provide.
Simplify your billing process for faster reimbursement
Nursing home administrators are always looking for ways to improve their facility’s bottom line. Nurses play a critical role in the Revenue Cycle Management (RCM) process. Understanding the process and staying abreast of coding and billing changes can ensure your facility is reimbursed accurately and efficiently.
Accurate and timely revenue cycle management requires constant interdisciplinary team coordination and communication with a shared vision for accurate coding and optimal patient care. Creating and adhering to an interdisciplinary team schedule results in a high level of teamwork and the highest standard of care. This will prevent important tasks from slipping through the cracks, leading to care delays and billing errors. Additionally, developing a consistent schedule for performing aging reviews and claim follow-ups will help identify potential issues so they can be resolved.
Use technology to your advantage to improve efficiency and accuracy
Technology can be a powerful ally in streamlining the revenue cycle for skilled nursing facilities. By automating workflows and leveraging analytics, SNFs can improve efficiency and accuracy while reducing errors and maximizing reimbursement.
Using analytics to regularly review the health of your revenue cycle, while tracking and trending progress will identify areas for improvement to streamline the billing process for faster reimbursement. Having a fully integrated Electronic Health Record (EHR) allows clinical data to seamlessly integrate into the billing cycle and save time and money by reducing errors and improving workflow. ‘efficiency.
Using technology to its fullest potential is key to optimizing the revenue cycle for skilled nursing facilities. Built-in RCM workflows help skilled nursing facilities maximize reimbursement while streamlining the billing process. By leveraging analytics to regularly review the health of your revenue cycle, you can identify areas for improvement and track progress over time. By automating workflows, leveraging analytics, and integrating clinical data, SNFs can improve efficiency, reduce errors, and maximize reimbursement.
Another factor is to-do lists without work, so that all tasks are completed accurately and on time. This allows providers to focus on areas needing attention and not issues already in progress, saving time that can be spent on residents.
Keep an open line of communication with payers and patients
Verifying insurance and coverage information for each patient is critical and should be done early and be an ongoing process throughout the patient’s stay. Knowing the correct payer to bill and the payer’s billing requirements ensures that your institution receives payment for your services.
Sharing this information with patients and their families is essential, so that they are aware of changes in eligibility and their responsibility for costs. All billing policies, payer coverage responsibilities, and schedules should be documented and communicated to patients, responsible parties, and families, as appropriate.
Set improvement goals and engage in continuous evaluation
Your goals should align with increasing positive patient outcomes that can be measured and tracked with analytics. Setting and meeting accounts receivable targets by payer, planning and performing aging reviews, and tracking claims will eliminate unnecessary problems. Survey your staff, patients and their families. When these groups all agree that the care provided is the best, a provider will be proud of their hard work and dedication.
Regularly monitor and review patient outcomes with analytics to ensure you are meeting your goals and making progress. Look for opportunities to improve patient care while reducing costs. Staying focused on the goals means you’ll provide quality care and generate the revenue needed to sustain and grow your organization. Critical thinking and creativity are key to developing new approaches and solutions.
Make sure your organization’s EHR experts keep up to date with new features and functionality to improve employee job satisfaction and quality of care, improve reimbursement, and provide training to all new employees after each release.
The financial and regulatory aspects of skilled nursing are becoming increasingly complex. Having a team dedicated to optimizing an organization’s revenue cycle can also be difficult to sustain amid the current staff shortage. Without the right people, the right processes, and the right technologies, skilled nursing organizations will grapple with impending financial challenges.
It’s important to remember that expert help is available outside of internal resources to help you identify issues in managing your revenue cycle, improve your cash flow and operate more efficiently. Outsourcing RCM services is an augmented approach that many are beginning to adopt to help streamline the revenue cycle and maximize current recoveries.
By following these tips, you can be sure to provide the best possible care to your clients and streamline your skilled nursing facility’s revenue cycle.
Jill Liila is Revenue Cycle Product Manager for MatrixCare Skilled Nursing, where she is responsible for the design and development of product features that comply with regulatory standards, optimize cash flow, increase productivity and reduce errors. She has has been a key revenue cycle player for MatrixCare Skilled Nursing since 2000 and has owned numerous positions, including Senior Business Analyst, working closely with clients at every stage of the path.
The opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its editors.