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.
Our medical billing services in Florida can help you to increase your revenue with the reduction in the number of denied and unpaid claims. Our billers present in all the major cities like Jacksonville, Miami, Tampa, St. Petersberg and Orlando can provide you with less paperwork and more accurate medical claims to improve the efficiency of your practice. Here are some of the services which our billers have shown their proficiency in:
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Claims are processed on the same day
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Analysis of accounts receivables
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Weekly as well as monthly reports on productivity
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Analysis of codes and procedures on a regular basis
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Review of fee schedules for updates
Comprehensive Medical Billing Services in Florida
As a Leading Medical Billing and Coding Service provider, we offer specialized medical billing services in Florida to optimize your revenue and reduce denied claims. We have a strong presence in major cities like Jacksonville, Miami, Tampa, St. Petersburg, and Orlando. Our billers and coders are experts in streamlining workflows and ensuring accurate claims submission.
They have over two decades of expertise in:
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Same-day claims processing to expedite payments.
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Detailed accounts receivables analysis to minimize A/R days
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Weekly and monthly productivity reports
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Regular code audits to maximize reimbursements
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Updating fee schedules for compliance and accuracy
Florida Medical Billing Experts Maximizing Your Practice Revenue
Our Florida-based professionals understand the state’s unique healthcare dynamics, including its extensive Medicaid Institutional Care Program (ICP) and high elderly population. By navigating state reimbursement statutes effectively, our coding specialists ensure compliance and better cash flow for your practice.
MBC’s medical billing experts in Florida offer tailored solutions:
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HIPAA-compliant processes to safeguard patient data
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Credentialing services to streamline payer enrolment
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Handling complex specialties like Cardiology, OB-GYN, Pediatrics, and more
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Expertise in EMRs and top billing software, including Medisoft, eClinicalWorks, and GE Centricity
Against Florida’s ongoing physician shortage, we help reduce administrative burdens while ensuring steady growth and profitability. By utilizing EMRs and advanced practice management systems, a Revenue Cycle Management Company optimizes operations and boosts collections significantly.
Our medical billers in Florida have been tracking the rate of reimbursements, which has been dipping in the state over the past decade. They have also analyzed the solution to this dip; the answer lies in the state of Florida’s reimbursement statutes themselves. These local Florida billers are the key to unlocking blocked cash flows and can provide you with updated methods to improve the efficiency of your practice.
Value Our Florida Billers Bring:
Our medical billing and coding services in Florida are not limited to major cities such as Jacksonville, Miami, Tampa, St. Petersburg, and Orlando. They also extend to almost all other towns and smaller cities in Florida. These medical coders and billers surpass HIPAA compliance and are trained in preferred languages such as Spanish. They have been recommended in their past engagements for their medical billing administrative skills, excellent Data Entry management, and good written and oral communication skills.
Our medical billers and coders in Florida perform specialized tasks such as reviewing encounter forms for accuracy in ICD-10 and CPT coding, maintain records of existing billing and coverage rules, posting charges and payments to accounts, make follow up calls to insurance companies to resolve any inconsistency in payments and to patients whose accounts were past due to set up a payment plan, report to physicians regularly, offer customer support by comprehending and elucidating insurance EOBs, co-pays, co-insurance and deductibles to patients and enter and revise patient demographics.
Our Specialties:
Our medical billing specialists in Florida can help increase your income and guarantee suitable reimbursement. They provide medical billing and coding services in specialties including Otolaryngology, Primary Care, Optometry, Family Practice, Hospitalist Billing, Cardiology, OB-Gyn, Physical Therapy, Paediatrics, Internal Medicine, and Dental.
Our Software Experience:
Physician shortage will always be a problem in Florida, affecting doctors and more prominent hospitals, hospices, nursing homes, nurses, and resident doctors. The shortage would mean long working hours and more accurate medical coding and billing practices. However, implementing EMRs is proving to be of immense help since most of the paperwork is diminished, and doctors have real-time information about patients and other related data. Our coders and billers are experts in software such as Medisoft, Misys Tiger, eClinicalWorks, Advance MD, GE Centricity, and Altapoint.
Difficulties & Challenges Florida Physicians Face:
One of the unique challenges that physicians and healthcare providers in Florida deal with is the Florida Medicaid Institutional Care Program (ICP). This is because Florida has a large elderly population (65 years and older), which is projected to grow to nearly 26% of the state’s total population, the highest among all states in the US.
These elderly patients are either disabled or fighting chronic illnesses, making them frequent visitors to physicians’ offices and various hospitals. This fact, coupled with the recent healthcare reform, would ensure that health care providers are required to ensure accuracy and compliance with legal guidelines to avoid a drop in revenue or negative legal repercussions. Our medical billing specialists ensure that problems such as inadequate reimbursement due to claim denial and other related factors do not take their toll on your practice.
Our Medical Billers and Coders can improve your practice's efficiency by employing the best methods of optimally using your EMR. Their exposure to various Practice Management Systems also provides greater collections for your practice.
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.
