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 billers and coders stationed in New Jersey, provide physicians with the latest in reimbursement strategies and government updates in terms of healthcare industry. Their presence across all major cities such as Newark, Jersey City, Patterson, Elizabeth and Edison offer Physicians options to locate well trained Medical Billers and coders easily.
These medical billers are equipped to reduce your overhead as well as perform complex administrative tasks. Their services guarantee many advantages and can help you to:
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Reduced overheads
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Patient eligibility verification in real time
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Expedite payments
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Reduction of rejected claims but follow up on them as well
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Increased productivity of in-house team
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Collection of overdue claims
Specialized Medical Billing Services in New Jersey
Our specialized medical billing services in New Jersey extend across major urban centers including Newark, Jersey City, Patterson, Elizabeth, and Edison. MBC's team helps practices navigate the unique challenges of America's most densely populated state, where healthcare demands continue to grow.
We deliver comprehensive solutions including real-time eligibility verification, expedited payment processing, and strategic denial management. Our experts maintain strong relationships with New Jersey's payer community, conducting detailed revenue analysis to maximize collections while reducing claim rejections. Through advanced EMR platforms and efficient processing systems, we help practices cut overhead costs while boosting in-house productivity.
New Jersey Medical Billing Specialists Drive Digital Transformation
In today's shifting healthcare landscape, New Jersey medical billing specialists support practices transitioning to digital systems while maintaining optimal revenue flow. Our certified team brings extensive experience with leading EMR platforms including Medisoft, Eclinicalworks, and GE Centricity, helping practices meet adoption deadlines and maintain HIPAA compliance.
We offer expertise across multiple specialties, from Optometry and Family Practice to OB-GYN and Hospitalist Billing, ensuring precise coding and efficient claims management. By combining proven payer relationships, strategic fee schedule evaluation, and proactive denial prevention, we help New Jersey healthcare providers maintain strong financial performance while adapting to industry changes. This focused approach enables practices to enhance patient care delivery while ensuring sustainable revenue growth in Garden State's competitive healthcare market.
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.
