Nursing homes and the services they offer are expanding and standards of care are rising, which is great news for patients and staff alike—but medical billing for nursing homes is more complicated than ever. In fact, some of the most complex restrictions in all the Medicaid and Medicare rules relate to nursing home care.
Outsourcing medical coding and billing has become a popular solution for medical institutions of all kinds and can be especially helpful for those running nursing homes. It is important to work with a professional organization, like Medcare MSO, with certified coders and staff who are all trained in HIPPA best practices and have experience with medical billing for nursing homes.
Why Outsource Medical Billing and Coding?
Running a nursing home requires medical staff to stay up to date on patient care and be available to handle emergencies. That doesn’t create the ideal environment for detailed paperwork, especially if staff are expected to do more than just the medical billing. It is far more efficient to have experts who deal only with coding and billing take care of it, so medical personnel can focus on patient care. These are just a few of the aspects that make medical billing for nursing homes so complex:
- Complicated Medicare rules: Medicare Part A provides coverage for nursing homes, but there are several conditions that must be met, and they can be very confusing. The patient must be receiving a skilled level of care related to a recent hospitalization, etc. Medical billers must be attentive to the details of coding for these patients or claims will be rejected.
- Multiple insurers: Medicare Part A covers a nursing home stay requiring skilled care for a limited time, but there are many people who must live in a nursing home, but not in relation to a condition for which they were recently hospitalized. There are some private insurers that provide long term care plans and Medicaid provides coverage for those who need to be in a nursing home but don’t have the money to pay for it. The amounts covered and conditions under which Medicaid applies vary from state to state.
- Consolidated billing: Most services and medications provided in a nursing home are included in the “consolidated billing” daily rate set by the Centers for Medicare & Medicaid Services (CMS), but there are several categories of exceptions, such as oncology. These claims for specialized services must be processed through the nursing home, so it is important for billers to be aware of what the additional services are, and how to code them correctly.
Medcare MSO Relieves Medical Billing Stress
Medical professionals are highly trained to care for patients, and coding and billing paperwork are often causes of stress and reduced job satisfaction. Medcare MSO, however, is dedicated to revenue cycle management (RCM) alone, and we have billers on staff who are certified and experienced in nursing home billing.
Our innovative approach to medical billing makes the process simple and efficient, starting with our proprietary software that makes sure all the latest code changes are incorporated. Our additional RCM services include annual pay back, compliance reviews, bill collection, payer credentialing and much more.
Get a free demo today to see how we can increase your revenue and relieve your staff of the stress of muddling through CMS rules to try and figure out how to stay in compliance. We are happy to answer any questions you may have.