6 key SNF billing compliance updates
Here are 6 key SNF billing compliance updates you must know:
- 8% Increase in SNF PPS Payment Rates
- PDPM Parity Adjustment Still in Focus
- New QRP Quality Measures (Effective October 2025)
- Expanded Value-Based Purchasing (VBP) Program
- ICD-10 Code Mapping Updates for PDPM
- Increased Staffing Data Scrutiny via PBJ Reporting
In April 2025, CMS released the FY 2025 Skilled Nursing Facility (SNF) PPS Final Rule, highlighting several critical regulatory changes for post-acute providers. These updates emphasize accurate coding, performance-based payment models, and enhanced data transparency, which are essential for SNF billing compliance.
As a Leading SNF billing service provider, Medical Billers and Coders is here to guide your facility through the most significant compliance updates of 2025.
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2.8% Increase in SNF PPS Payment Rates
CMS approved a 2.8% net rate increase for SNFs in FY 2025, amounting to an estimated $1.5 billion in additional funding. While this offers a revenue opportunity, CMS will monitor billing accuracy more closely.
Compliance Tip:
Ensure proper MDS coding and documentation. A reliable SNF billing service provider can help reflect rate updates correctly while avoiding billing discrepancies.
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PDPM Parity Adjustment Under Review
The existing 4.6% PDPM parity reduction remains unchanged, but CMS has continuously evaluated the payment model. Expect continued oversight on clinical category coding and utilization.
Compliance Tip:
Audit PDPM coding regularly and align care documentation with billing. Partnering with an experienced SNF billing company helps reduce errors and withstand audits.
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New SNF QRP Measures Begin October 2025
Three new quality measures will be tracked starting in October:
- Discharge Function Score
- HAIs requiring hospitalization
- Falls with major injury
These will impact Medicare payments in FY 2027.
Compliance Tip:
Begin collecting accurate QRP data now. SNFs failing to report face a 2% payment cut. Medical Billers and Coders can help align your reporting systems with CMS requirements.
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Expanded Value-Based Purchasing (VBP) Program
CMS is expanding VBP metrics, including:
- Discharge to the community
- Medicare spending per beneficiary
- Staffing data, like turnover and weekend coverage
Compliance Tip:
These metrics will influence future payment incentives. A knowledgeable SNF billing service provider can help integrate quality data into your billing and compliance workflows.
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ICD-10 Code Mapping Changes for PDPM
Revised ICD-10 mappings affect PDPM classification, particularly neurological, respiratory, and orthopedic conditions.
Compliance Tip:
Update coding protocols and train staff accordingly. Incorrect mapping can trigger audits or denials. Let Medical Billers and Coders review your claims for compliance accuracy.
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Staffing Data Scrutiny via PBJ Reporting
CMS will increase reliance on Payroll-Based Journal (PBJ) data to evaluate staffing levels and turnover. This data now impacts both reimbursement and star ratings. (Ref No. 1)
Compliance Tip:
Ensure PBJ submissions are accurate and timely. Collaborate with an SNF billing service provider to integrate staffing data into your compliance checks and billing audits.
Why SNF Billing Compliance Matters More Than Ever?
SNF billing compliance is no longer just about submitting clean claims—it’s about aligning operations, documentation, and staffing with CMS’s growing expectations. Non-compliance can result in denied claims, penalties, and reduced payments.
How Medical Billers and Coders Can Help?
As an expert SNF billing company, we offer:
- PDPM compliance audits
- ICD-10 and CPT coding support
- QRP and VBP data tracking
- Denial management and appeal services
- PBJ and staffing compliance integration
We help skilled nursing facilities avoid penalties, maintain billing accuracy, and stay compliant.
Medical Billers and Coders — Your Partner in SNF Billing Compliance.
Source URL:
Ref No. 1 Payroll Based Journal Daily Nurse Staffing: https://data.cms.gov/quality-of-care/payroll-based-journal-daily-nurse-staffing
Ref No. 2 PDPM Calculation Worksheet for SNFs: https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/downloads/mds_manual_ch_6_pdpm_508.pdf
FAQ:
SNF billing compliance refers to adhering to CMS guidelines, coding standards (like ICD-10), quality reporting requirements (QRP), and staffing data accuracy (PBJ) for Skilled Nursing Facilities. In 2025, stricter audits and expanded value-based models mean facilities must ensure that accurate clinical documentation supports every claim and meets reporting deadlines to avoid penalties.
Inaccurate ICD-10 coding can misclassify patients in the PDPM system, resulting in underpayment or overpayment—both can trigger CMS audits or repayment demands. Staying current with updated mappings is essential for correct reimbursement and compliance.
An SNF billing service provider, like Medical Billers and Coders, offers expert services in coding, claims submission, compliance audits, denial management, and CMS metric reporting. Their role is to ensure that all claims are accurate, properly documented, and submitted by changing regulations.
Yes. With increased oversight on PDPM coding, staffing transparency, and QRP submissions, facilities should proactively prepare for data validation audits and documentation reviews. Working with a medical billing partner ensures claims are defensible.
Physicians are focusing more on aligning clinical documentation and ICD-10 diagnosis selection. They’re asking billing teams for pre-claim audits and real-time feedback on documentation that affects PDPM scoring.
Physicians and administrators are exploring linking clinical quality tracking with billing systems. They’re seeking dashboards and reports that monitor discharge rates, infection scores, and spending per beneficiary—metrics that now influence financial outcomes.
Yes. Many SNFs are outsourcing billing and regulatory reporting support. A comprehensive SNF billing service provider like Medical Billers and Coders can assist with claims submission and quality measure compliance.
