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 billers and coders in Maryland work with the sole purpose of providing quality medical billing services to physicians. They are dedicated to providing you regular cash flow for your practice since they have an overall understanding of the dynamic nature of healthcare insurance. This knowledge and understanding has come to them as a result of years of training in the state of Maryland.
These billers believe in being close to their physicians to resolve any issues that may spring up and therefore are present in all cities of Maryland like Baltimore, Rockville, Frederick, Gaithersburg and Columbia. Besides they have the required expertise to successfully operate with different specialties across all healthcare practices. Some of the services which our medical billers specialize in are:
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Coding with CPT and ICD-10
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Electronic submission of claims
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Accounts receivable management
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Patient billing and collections
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Customized reporting
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Compliance to HIPAA and other rules and regulations
Comprehensive Medical Billing Services in Maryland
MBC experts in Maryland provide quality medical billing services to physicians, ensuring consistent cash flow. With 25 years of experience and a deep understanding of healthcare insurance, we’re equipped to navigate billing complexities. Our MBC billers are located in major cities like Baltimore, Rockville, Frederick, Gaithersburg, and Columbia, offering specialized services tailored to each physician's needs. Key services include:
- Coding with CPT and ICD-10
- Electronic submission of claims
- Accounts receivable management
- Patient billing and collections
- Customized reporting
- HIPAA compliance and adherence to other healthcare regulations
Maryland Medical Billing Specialists Financially Empowering Your Practice
MBC billers are dedicated to relieving your staff of excessive multitasking, increasing both productivity and profitability within your practice. Our ability to design efficient billing patterns and smoothen workflow can significantly enhance your operations in just a few weeks. We have been serving local physicians for years and maintain strong relationships with both public and commercial carriers, ensuring efficient processes for your practice.
MBC billers in Maryland are well-versed in state regulations and leverage their extensive experience to ensure your practice’s billing is compliant. This knowledge and expertise allow them to maximize revenue, reduce costs, and support the federal government's efforts to reduce healthcare costs. By outsourcing your medical billing, you could see significant improved collection.
With accurate coding, code audits, and timely insurance follow-ups, MBC billers in Maryland are focused on achieving higher profitability for your clinic. Our experience with a variety of billing software and certifications ensures that your practice will grow steadily while maintaining high standards of service and compliance.
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.
