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Skilled Nursing Facility Billing Services Tennessee, TN

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 Tennessee medical billers and coders have been helping local healthcare professional in and around the state for many years now. They all seem to have collected their knowledge with years of practice of dealing with local payers.

They work towards eliminating your outstanding accounts receivables and make your reimbursement process seamless. They have been catering to major Tennessee cities like Memphis, Nashville, Knoxville, Chattanooga and Clarkesville and are willing to travel to your clinic anywhere in Tennessee.

These proficient billers provide customized services to meet the requirement of your practices. Some of the services our professional medical billers can help you with:

  • Accurate and prompt verification of benefits
  • Scheduling appointments
  • Complete charge entry for claims
  • Posting Payment regularly
  • Electronic Claims transmitted through carriers or clearing house
  • Thorough audit before transmitting claims

Over the last few years gross charges denied have grown to 18%, based on estimation for US healthcare providers. This has made the physicians from Tennessee worry about denial ratio.

Consulting professionals or expert medical billers and coders to understand the major reasons for denials works well with busy physicians. Our Billers can consult with you for your accounts receivables and insurance follow-up by being an extension for your practice. Moreover they are also proficient in medical terminology, disease processes, anatomy and physiology, life cycle of an insurance claim, health care settings, health care payers, procedure and diagnosis coding from medical records, reimbursement systems, surgical procedures, facility billing, and medical practice management systems.

Value Our Tennessee 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. By using EMR that is efficient our medical billers and coders are quick in patient statement processing which can be an increasing burden due to the rising demand for medical services. Our medical coders and billers at medicalbillersandcoders.com also have solid relationships with key insurance companies across the nation and state so that any delays or errors can be avoided when dealing with insurance matters such as claims denial and in revenue cycle management.

Billing and coding services provided by our billers and coders are a mix of specialized professionals with wide ranging skills such as insurance collections, patient statements processing, claims management, fee schedules evaluation, and the ability to establish effective relationships with patients and insurance companies and expertise with patient accounting software. With in-depth knowledge of the medical billing and coding and compliance of HIPAA guidelines, it would become easier for you to ensure that revenue and quality of patient services is not affected due to errors in medical coding and billing.

Their skills with Insurance eligibility verification and account receivables follow up, is the main reason for many Tennessee clinics to experience a growth of 20% in revenues with their Medical billing services.

Our Specialties :

Our billers and coders are specialized in various areas such as Optometry, Family Practice, chiropractic, OB Gyn, Physical Therapy, oncology, Pediatrics, urology, and Hospitalist Billing. All the medical billers and coders at medicalbillersandcoders.com are familiar with ICD9 and CPT Coding which make them preferable choices for physicians. Many of our medical billers and coders provide value added services to offer through specialized services like evaluating fee schedules, helping you prepare online super bills and diagnosing major reasons for denials.

Our Software Experience :

With the implementation of efficient EMR software our medical billers and coders ensure a paperless, time saving, and efficient medical billing system. The EMR software which they are already trained on include Medisoft, Misys Tiger, Eclinicalworks,Advance MD, GE Centricity, and Altapoint. Using these software would not only save time but also assist you in handling the increase in demand for your services as a health care provider. The Practice Management software that we provide in addition to the value added services mentioned above ensures that physicians in Tennessee are able to keep up with the healthcare IT sector reforms and improvements.

Problems Tennessee Physicians Face :

Physician shortage is a huge problem in Tennessee and increasing number of patients in the near future would mean requirement of experienced and skilled medical billers and coders. Moreover, lesser claim denials may be expected due to the health reform which makes it imperative that you have a flawless and professional team of medical billers and coders. Our expert medical billers and coders ensure quality revenue cycle management service across almost all the counties and cities in Tennessee and not just big cities such as Memphis, Nashville, Knoxville, Chattanooga and Clarkesville.

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.