A practice that is focused on physicians is a practice functioning smoothly. So, having just one task to complete (sorting payments) will mean that physicians are able to concentrate more on the patient’s treatment. This improves the efficiency of staff as well as the overall satisfaction of the patients. By skilled nursing facility billing and coding to outside companies, Your medical practice will run more smoothly while allowing you to concentrate on the things that really need attention from the team and that is caring for patients.

Nursing Home Billing

Denial 1: Certification or Recertification Statement (Missing/ Lacked Information)

Between 2012 and 2014, the proportion of payments that were not properly made to SNF nearly doubled, with the majority due to the failure to get the certification or recertification.

General Guidelines:

The Certification Statement should state that the individual needs skilled nursing (furnished directly by or requiring the supervision by skilled nursing staff) as well as skilled rehabilitation every day in a nursing home billing services or a swing-bed hospital as an inpatient. It is crucial to note that services must be linked to a condition that is ongoing in which the patient was treated impatiently at the hospital. For example admission to a hospital for CVA and then transfer to an SNF for the aftercare of CVA. 

The form should be signed by the physician who certifies the patient as well as the NPP when the patient is admitted, or whenever it is practical or feasible. The date and signature must be written in the same font and in the same manner and cannot be dated on this form on their behalf, and this is a reason for refusal.

The certification statement must include the following:

• The patient requires expert services every day. (nursing and other rehab services)
• The day-to-day skilled services are only available in an SNF
• Why you need skilled assistance
• Signature of the medical professional employed at SNF who is aware of the incident or a physician extender

Recertification statements must contain the following information:

The reason why nursing home billing companies are a demand for care services for an extended duration. The time period necessary for the patient to remain in the hospital. Any plans, if appropriate, to provide the home care of your loved ones. A signed date by the medical professional in the staff of SNF who is aware of the situation or a physician extender. Revocation of certification or recertification can occur in these scenarios.

The certifications must be obtained at the admission time or as soon after as is practical and reasonable. The recertification first must be completed by 14th-day post-hospital extended care inpatients. The re-certifications will be issued every 30 days. Recertifications and certifications delayed for a period of time should include an explanation of the delay as well as any other medical or other evidence that could be relevant for reasons of explaining the delay.

How can we be sure to avoid this denial?

Certificates are required when admission is granted, or as soon as is practical and reasonable. The initial recertification should be completed no later than the 14th day after the post-hospital extended inpatient care. The re-certifications will be issued every 30 days. Recertifications and certificates that are delayed are required to include an explanation of the delay as well as any other medical or other evidence pertinent to the purpose of explaining the delay.

Denial 2: Insufficient Documentation (To Support the Services Provided)

• Most of SNFs incorrect payments to service providers resulted due to inadequate documentation.
• Refusal due to insufficient documentation can be the case in one of the scenarios below:
• The actual hours of therapy recorded in the treatment records were not as long as the time listed by the nursing home billing for physical therapy (PT) or occupational therapy (OT) or speech-language pathology (SLP) services.
• The documented skilled services offered did not meet the requirements of the level of the Resource Utilization Group III (RUG-III) amount that was charged.

How can you be sure to avoid this denial?

The claims for skilled care insurance must be supported by sufficient evidence that will allow a reviewer to decide:

• The recipient requires skilled involvement to provide the service efficiently and safely.
• The services are reasonable and are necessary to treat an injury or illness. For instance, the services must conform to:
• The severity and nature of the injury or illness
• The specific medical needs of each patient and the accepted guidelines for medical practice

The records of the medical records of the beneficiary must be exact and free of the insufficient and subjective descriptions of the care provided to the resident which is not enough to demonstrate the need for skilled medical care. Documentation must also prove that the services are suitable in terms of length as well as quality and support the stated therapeutic goals. 

The goals of the beneficiary must be regularly examined and documented in order to provide a valid basis to determine Medicare coverage. So, the resident’s medical record should include what is necessary. The physical and medical history relevant to the care of the resident (including the reaction or change in behavior to skilled services previously administered)

The expert services offered

• The resident’s response to the professional services that were provided in the current visit
• The future plan of care was based on the reasoning behind previous results
• A thorough rationale for the necessity for the expert service given the medical conditions of the resident and personal experiences
• The complexity of the task to be provided
• Other relevant aspects of the person who lives there
• Medical records should also prove the medical necessity for SNF services offered. Examples of the mandatory documents can include, but aren’t restricted to:
• A certificate that states that the person required daily skilled care may only be given in an SNF setting.
• A valid plan of treatment

The duration (in minutes) of the treatment services offered

The home health billing company’s process is the most crucial element of a facility’s financial viability. Medcare MSO Medical Billing offers all the nursing home billing companies and assistance you require to increase your profits. Alongside the consultation and collections assistance, we offer, using our nursing home medical billing will give you the additional moment and calm mind that you require. Utilize that time to address problems, prepare yourself to be successful, or give yourself the chance to get back on track with the new start you require.

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