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.
Many providers in Washington are exploring various options of optimizing their billing and medical billing process by hiring specialists locally. These physicians expect their specialists to handle their medical billing and be involved with any day to day operations.
They can help you streamline your medical billing process by customizing the services which will ultimately decrease your efforts and increase your productivity. These certified Medical Billing Specialists are located in major cities like Seattle, Spokane, Tacoma, Vancouver and Bellevue and provide services such as:
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Timely submission of electronic claims
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Posting EOB and verifying ERA postings
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Preparation of patient statement
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Accounts receivable management
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Handling Billing and reimbursement inquiries
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Verifying Benefits of patients
Specialized Medical Billing Services in Washington
Our specialized medical billing services in Washington support healthcare providers across Seattle, Spokane, Tacoma, Vancouver, and Bellevue. We deliver comprehensive Revenue cycle management solutions, including electronic claims submission, ERA verification, patient statement management, and strategic accounts receivable oversight.
Understanding Washington's stringent fraud prevention measures and Department of Social and Health Services requirements, our experts ensure complete compliance while maximizing legitimate reimbursements. Through detailed analysis of partial payments and denials, we implement effective appeals processes to optimize revenue recovery.
Washington Medical Billing Specialists Enhance Practice Performance
Our medical billing experts in Washington combine local expertise with proven revenue optimization strategies. Through efficient benefits verification, proactive claims management, and systematic payment tracking, we help practices improve collections by 20%.
Our certified medical coding team maintains a thorough understanding of state regulations, providing customized solutions that reduce administrative burdens and increase productivity.
By leveraging advanced billing knowledge and established processes, we help Washington medical practices achieve sustainable growth while meeting federal cost-reduction initiatives. This comprehensive approach enables healthcare providers to maintain strong financial performance while ensuring regulatory compliance.
With a claim partially paid or rejected, it is important that the explanation of partial payment or rejection is looked into and understood by billing experts.
Our billers in Washington can take care of that. They would track and deal with even the last dollar on your behalf. Some of these billers specialize in writing appeals and reversing denials.
They also understand the efforts taken up by the state legislators to reduce and detect fraud and insurance abuse. They strive to provide the best medical billing and coding practices and conform to the Department of Social and Health Services.
Take the time to evaluate the best resource in the industry, as this one-time investment will ensure you a lifetime of trouble-free medical billing in Washington.
Our Billers in the state of Washington are specialized to service medical practices as per the regulations of the state government. Their knowledge and experience have been acquired by 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 the state of Washington by optimizing costs and enhancing revenue. Let a Leading Medical billing company handle your medical billing. This can help you increase collections by 20%.
Accurate Coding and code audit, along with timely insurance follow-up and account receivables, are the basis on which these billers in Washington 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.
