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Skilled Nursing Facility Billing Services Michigan, MI

Until 1998, nurse center billing was quite an easy thing to do since skilled nurse facilities (SNFs) could bill separately for their service. Since 1998, after the Balance Budget Act came into effect, several things about how SNFs claim their reimbursement have changed. The points below will outline the changes:

Challenges of Skilled Nursing Facility Billing

Producing SNF claims as part of consolidated billing requires the knowledge of codes as also familiarity with what is covered by Medicare A and what’s not. If something is not covered by Medicare A, then it may be covered by Medicare B. The SNF has to identify that and bill it separately.

On the other hand, payment on per diem basis means a fixed amount CMS pays to SNFs under Medicare A with which SNFs pay contracted nursing service providers for their services.

  • Now SNFs have to produce their claim as part of consolidated billing under the Prospective Payment System (PPS)
  • SNFs are paid by Medicare A on a per diem basis

Our medical billers in Michigan can specifically customize their billing processes to meet your requirements. We have a reach in almost all the major cities of Michigan such as Detroit, Grand Rapids, Warren, Sterling Heights and Flint.

It has always been the goal of our medical billers and coders to provide better Medical Billing Services which exceed your expectations. They can provide you with a platform for electronic medical billing and also suggest easy to use software. Installing a Practice Management Software and help you set up your workflow so that you can keep a track of your billing. Some of the services which they specialize in are:

  • Patient demographics entry and insurance verification
  • Account receivables management
  • Physician credentialing where required
  • Customized reports on revenue collections
  • Code audits for ethically maximizing revenues

Our medical billers and coders can help you focus on patient care in your practice rather than on paperwork or your administrative staff. They can also guarantee you constant cash flow without leaves or downtime.

The goal of our billers and coders in Michigan, one of the states with the best medical billing and coding schools is to provide you experienced and well trained resource so as strengthen the growth process of your clinic. These medical billers and coders are experienced and trained in numerous areas such as denial management, medical claims processing, medical collection, and medical claims examination.

Value Our Michigan Billers Bring:

Our medical billers and coders are experienced in insurance collections which can be a tedious job for someone who lacks experience in this area. They also understand how critical timely insurance collections are for the physician as well as the patient. Our medical coders and billers at medicalbillersandcoders.com also have solid relationships with key insurance payers, like BCBS, United Health, Workers Comp and government payers across Michigan. These daily interactions with payers ensure that delays or errors in claims management can be avoided.

The skill of our billers is enormous and includes but is not limited to Past Due Collections, Electronic Medical claim filing, Medicare Audit Protection, coding and diagnosis analysis for highest permissible reimbursement, custom-made accounts receivable reports, revenue cycle financial analysis, electronic claims submissions, patient statements and patient-centric support, denials management and payment posting, committed and persistent insurance follow-up, provider enrollment support, and standardized reporting. Moreover our billers are compliant with HIPAA guidelines and are updated with all industry updates through medicalbillerandcoders.com.

Our Specialties:

Our team of medical billers and coders has experience in various areas of specialization such as Physical Therapy, neurology, occupational health, Family Practice, OB Gyn, Hospitalist Billing and numerous other areas. This in-depth knowledge makes them ideal for catering to your requirement of medical coders and billers who can perform in almost every specialized area of medicine. Their experience and relationship across all kinds of payers helps your clinic collect better revenues.

Our Software Experience:

These billers and coders are also proficient in using various EMR software and can ensure a paperless and quick revenue cycle management. Some of the EMR software that our medical billers and coders are proficient in include Medisoft, Misys Tiger, Eclinicalworks, Advance MD, GE Centricity, and Altapoint. These software ensure quick reimbursement for the services that you provide, a paperless environment, and increased revenue because of the accuracy and professionalism of our billers and coders.

Problems & Challenges Michigan Physicians Face:

Michigan is one of the better ranked states in the United States as far as health care is concerned but some problems such as lack of adequate nursing home care and lack of chronic care measures implicate increased number of doctor-patient encounters in the future, as steps are taken to provide insurance to the majority of population. To meet this demand for health care services, our medical billers and coders not only operate in big cities such as Detroit, Grand Rapids, Warren, Sterling Heights and Flint but also in all other counties, smaller cities, and towns in Michigan.

The most common challenges faced by physicians in big cities such as Detroit and Grand Rapids are underperforming accounts receivables or claims denial and collections. Both these situations might lead to diminished revenue. Our billers offer the solutions to these problems by streamlining the denial management process and offering services such as integrated medical billing with EMR. These Billing specialists believe in providing many other value added services such as sending patient statements and processing refunds to Medicare in order to preserve your practice from RAC audits.

Nursing Facilities are exposed to the below problems-

  • Inaccuracy of codes applied leading to rejection of claims
  • Insufficiency of knowledge of items covered by Medicare A and B
  • Fixed or per diem payments for services not accommodating cost borne by the nursing facility adequately - given that there is a degree of cost elasticity in the range of services offered by facilities, which the fixed rates often fail to encompass

The above two scenarios expose nursing facilities to two kinds of revenue leakage: one is via rejected claims; another is through underpayment of services.

Additionally, it’s often difficult to establish that the patient required the services provided by a nursing facility and excessive time spent on non-medical activities.

Outsourcing Skilled Nurse Facility Billing to MBC

MBC has helped nursing centers both in rural and urban US (more in rural as that’s where nursing facilities are mostly concentrated) across all 50 US states, to improve their revenues by reducing reimbursement rejection rates and increasing their focus on nursing services. MBC’s billers and coders come with extensive knowledge of billing and coding intricacies so that they can take care of the entire cycle of billing and coding needs starting from identifying patient eligibility for reimbursement to accurately separating items covered by Medicare A and Medicare B. They also perform post-claim-submission follow ups to ensure timely reimbursement of payments by CMS.

Our flexible service models ensure that you can choose a solution that fits your needs and setup. We offer varied service models including in-house service model; where providers can source in-house skilled nursing facility billers and coders through the MBC job portal.

If you don’t have an inbuilt team of billers and coders nor any need to have one, our outsourced billing and coding model will suit you helping you to ship out all your billing and coding responsibilities to us, so that you can solely concentrate on delivery of nursing care. Our outsourcing model includes the entire range of billing and coding activities starting from identifying insurance eligibility of the patient to submission of claims and post submission follow ups.

Our RCM consulting model involves a thorough study of your revenue management cycle to spot areas of revenue leakage and plug them by helping reduce outdated or cumbersome processes, and assist in replacing inept software applications with new ones customized to your need and environment along with help in training people where required.

MBC’s national network also comes with local knowledge and familiarity so that we understand your operating environment and help you meet your state-and-location specific needs.