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.
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Now SNFs have to produce their claim as part of consolidated billing under the Prospective Payment System (PPS)
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SNFs are paid by Medicare A on a per diem basis
Skilled Nursing Facility billing operates within one of the most regulatory-dense reimbursement frameworks in post-acute care — where revenue is governed by PDPM component capture, accurate RUG classification, and the precise documentation of therapy minutes, nursing intensity, and non-therapy ancillary services that CMS and payers audit continuously.
MBC acts as your Revenue Integrity Partner by ensuring that every SNF stay is reimbursed to its highest defensible PDPM accuracy, ICD-10 diagnosis sequencing correctly reflects clinical complexity, and payer policies around consolidated billing, Medicare Part A spell-of-illness management, and Minimum Data Set (MDS) assessment windows are executed with precision — so your facility retains every dollar it clinically justifies.
Running a medical practice in California can be quite challenging when it comes to Medical Billing and coding. Our billers and coders in all the major cities of California including Los Angeles, San Diego, San Jose, San Francisco, Fresno can help you settle your requirements here are some of the services which our expert medical billers and coders specializes in:
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Tracking and follow-up on unpaid claims
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Preparing Patient statements and payment posting
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Customizing billing reports for better control
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Primary and secondary insurance claims filing
Expert Medical Billing Services in California
Managing a medical practice in California presents unique challenges. However, a Top medical billing Company in major cities like Los Angeles, San Diego, San Jose, San Francisco, and Fresno helps physicians have smooth billing operations.
Skilled Medical Billing and Coding Service Provider specializing in streamlining revenue cycles, ensuring accurate data entry, coding, and payment review, and maximizing clean claims for faster reimbursements. MBC is your partner for financial growth, focused on optimizing your cash flows and alleviating your administrative burden.
Comprehensive Billing Services by MBC Experts
Medical Billers and coders (MBC) offer an extensive range of services designed to optimize operations for healthcare providers, including:
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Tracking and follow-up on unpaid claims
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Electronic and paper claim submissions
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Payment and adjustment posting
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Primary and secondary insurance claims filing
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Customizing billing reports for better control
With expertise in accurate coding, detailed code audits, and consistent insurance follow-ups, we help mitigate underperforming accounts receivables, collections, and claims denials that frequently affect practices in cities like San Jose and Los Angeles.
Physicians in California face evolving legislation, payer denials, and increasing patient-doctor encounters, making billing and coding a difficult task. Our coding specialists ensure practices remain compliant with HIPAA regulations, addressing:
Expert medical Billing and Coding Service Providers in California ensure compliance with state and federal regulations, improve collections by up to 20%, reduce costs, and optimize operations. By outsourcing to MBC, practices can focus on patient care while achieving steady growth and higher profitability.
Value Our California Billers Bring:
Medical Billers and Coders are not limited to the big cities such as Fresno, San Francisco, and San Diego but also all other smaller cities and towns in California. Moreover, our billers comply with HIPAA guidelines and are updated with all industry updates through medical billers and coding. This ensures your practice is run in the most efficient and legally safe conditions. Our Billing specialists also ensure that your patients are hassle-free and that their billing queries are answered well.
The expertise of our billers is vast and includes but is not limited to Past Due Collections, Electronic Medical claim filing, Medicare Audit Protection, coding and diagnosis analysis for maximum allowable reimbursement, customized accounts receivable and revenue cycle financial analysis, electronic claims submissions, denials management and payment posting, dedicated and relentless insurance follow-up, patient statements and patient-centric support, provider enrolment support, and standardized reporting.
Our Specialties:
Medical Billers and Coders (MBC) is committed to improving your productivity by utilizing the finest processes and healthcare information technology such as Electronic Medical Records. These medical billers and coders maximize your revenue, ensure timely compensation, and offer Medical Billing and Coding Services including Family Practice, mental health, pain management, Physical Therapy, Radiology, Internal Medicine, Neurology, Orthopedics, and numerous other areas.
Our Software Experience:
According to the AAMC (Association of American Medical Colleges), the physician shortage will quadruple in the next decade, so physicians must utilize professional and accurate medical billing and coding services. The various software we provide and the value-added services mentioned above ensure that physicians can keep up-to-date with healthcare IT sector reforms and improvements. Some of the medical coding and billing software our billers have experience with include Medisoft, Misys Tiger, eClinicalWorks, Advance MD, GE Centricity, and Altapoint.
Difficulties & Challenges California Physicians Face:
The most common challenges physicians face in big cities such as San Jose and Los Angeles are underperforming accounts receivables or collections and claims denial. These situations, along with other errors, may lead to decreased revenue. Our billers solve these problems by making denial management efficient and offering services such as integrated medical billing with EMR. They also offer numerous other value-added services like sending patient statements and processing refunds to Medicare, to preserve your practice from RAC audits.
As a physician in California, tracking all the legislation-related changes to your practice becomes difficult. This is where the expertise and experience of our medical billing specialists can be of immense help. Payers are in the business of claim denial and can afford to make mistakes at your expense. Although the new HIPAA guidelines would ensure a smoother process, the number of patient-doctor encounters would increase, making it difficult to extract time for coding, billing, claim denial, and compliance with HIPAA regulations. Specialized medical billers and coders like ours can ensure that your practice flourishes and is HIPAA compliant.
Nursing Facilities are exposed to the below problems
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Inaccuracy of codes applied leading to rejection of claims
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Insufficiency of knowledge of items covered by Medicare A and B
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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.
Skilled Nursing Facilities lose significant revenue through inaccurate PDPM component scoring, missed non-therapy ancillary charges, and consolidated billing violations that trigger claim reductions and audit exposure without internal detection.
MBC's Revenue Diagnostic evaluates your SNF billing at the payer, stay, and assessment level — identifying where PDPM case-mix capture is underperforming, which Part A and Part B claims are failing adjudication and why, and how your AR aging and Medicare census mix compare against post-acute benchmarks. The output is a clear, actionable breakdown of the revenue your facility is currently leaving uncollected.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 the 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.
Skilled Nursing Facility billing is a census-driven, compliance-intensive discipline where PDPM miscalculation, MDS timing errors, and consolidated billing gaps compound across every resident stay — quietly eroding margins that facilities cannot recover retroactively.
MBC helps SNFs Yield your EBITDA by maximizing reimbursement accuracy across all five PDPM payment components, reducing denials on Part A stays and Part B therapy claims, and ensuring that every billable service delivered — from high-acuity nursing care to non-therapy ancillary utilization — is captured, coded, and collected in full. The result is a billing operation that turns your daily census directly into sustainable financial performance.
MBC 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.
