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 have been serving physicians in the state of North Dakota for more than a decade now. With these years of experience these billers have developed a deep expertise in almost all the specialties and are available in major cities of North Dakota like Fargo, Bismarck, Grand Forks, Minot and West Fargo
They can provide all the medical billing services or any particular functions as per your requirement, from the below:
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Patient demographics and charge entry
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Coding with CPT, ICD-10 and HCPCS
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Charge creation
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Payment posting
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Writing appeals
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Financial reports on a monthly basis
Specialized Medical Billing Services in North Dakota
Our specialized medical billing services in North Dakota extend across Fargo, Bismarck, Grand Forks, Minot, and West Fargo, with a decade of proven expertise. MBC's team provides comprehensive services including patient demographics management, CPT, ICD-10, and HCPCS coding, payment processing, and detailed financial reporting.
We maintain established relationships with major state payers including Medicaid, Medicare, Workers Compensation, BCBS, and United Health, ensuring efficient claim processing and optimal reimbursement rates. Our certified professionals understand North Dakota's complex healthcare billing requirements, delivering precise solutions tailored to each practice's needs.
North Dakota Medical Billing Specialists Drive Practice Success
Our North Dakota medical billing specialists combine in-depth knowledge of state regulations with proven revenue optimization strategies. Through accurate coding, strategic appeals management, and consistent payer follow-up, we help practices improve collections by 20%.
Our certified team addresses the evolving complexities of medical billing, ensuring practices maintain compliance while maximizing revenue potential. By providing expert end-to-end billing management and regular financial reporting, we enable healthcare providers to focus on patient care while maintaining strong financial performance.
Our comprehensive approach supports steady practice growth while meeting federal cost-reduction initiatives in North Dakota's dynamic healthcare environment.
Medical billing services in North Dakota start with an understanding of all major payers in this state, including Medicaid, Medicare, Workers' compensation, BCBS, and UnitedHealth. Working with these payers over many years locally has helped these billers develop strong relationships, which benefit your practice in the long run.
Though North Dakota Healthcare is picking up, the level of expertise required to handle the coding process can be complex and must be handled by certified personnel who understand the job well. Our Billers and Coders are adept at handling medical billing end-to-end.
Our Billers in North Dakota specialize in servicing medical practices according to state regulations. Their knowledge and experience have been acquired through years of effort in perfecting medical billing procedures, which they now leverage to help your practice collect more revenue.
The federal government's effort to reduce healthcare costs can only be supported by physicians in North Dakota by optimizing costs and enhancing revenue. Letting a specialist handle your medical billing can help you improve collections by 20%.
Accurate Coding and code audit, along with timely insurance follow-up and accounts receivable, are the basis on which these billers in North Dakota guarantee higher profitability for your clinic. Their experience in various software and certification in the medical billing processes will support your practice to grow steadily.
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.
