Skilled Nursing Facilities (SNFs) in Wisconsin face an increasingly complex billing landscape as Medicare Advantage enrollment continues to climb. With 129 Medicare Advantage plans now available in the state, SNF RCM in Wisconsin must adapt to evolving payer requirements. Understanding the fundamental differences between traditional Medicare Part B and Medicare Advantage billing has become essential for maintaining healthy revenue cycles and ensuring consistent reimbursement.
The Growing Medicare Advantage Challenge
The shift toward Medicare Advantage isn’t slowing down. Nearly half of Medicare beneficiaries now choose Medicare Advantage plans over traditional Medicare, creating a dual-track billing system that SNF administrators must master. Each path comes with distinct rules, reimbursement models, and documentation requirements that directly impact your facility’s bottom line.
For SNFs already managing tight margins and staffing challenges, billing errors can prove costly. The difference between accurate Medicare Part B billing and Medicare Advantage billing isn’t just procedural—it’s financial.
Medicare Part B Billing for SNFs: The Traditional Route
Traditional Medicare Part B billing for skilled nursing facilities follows a standardized, federally regulated structure. In 2025, the Part B deductible stands at $257, with patients typically responsible for 20% coinsurance after meeting their deductible.
Key characteristics of Medicare Part B SNF billing:
Medicare Part B covers ancillary services provided to SNF residents who aren’t in a covered Part A stay. These services include physician visits, diagnostic tests, outpatient therapy, and durable medical equipment. The billing process follows consistent Medicare guidelines across all facilities nationwide, with claims submitted to your designated Medicare Administrative Contractor.
The consolidated billing rule under Part B means SNFs must bill for most services provided to residents during a non-covered stay. This includes items and services that would otherwise be billed separately by outside providers. Understanding which services fall under consolidated billing versus those that can be billed separately requires careful attention to Medicare guidelines.
Medicare Advantage SNF Billing: The Complex Alternative
Medicare Advantage plans operate under an entirely different framework. These private insurance plans contract with Medicare to provide Part A and Part B benefits, but they set their own rules, authorization requirements, and reimbursement rates within federal guidelines.
What makes Medicare Advantage billing challenging:
Each of the 129 plans available in Wisconsin maintains unique prior authorization requirements, documentation standards, and claims submission processes. A billing approach that works perfectly for one plan may result in denials from another. Network status matters significantly—whether your facility is in-network, out-of-network, or operates under a specific contract affects both reimbursement rates and patient cost-sharing.
Authorization timelines vary dramatically between plans. Some require pre-authorization for admission, while others request authorization for continued stays or specific services. Missing an authorization window often means automatic denial, even when care was medically necessary and properly documented.
Unlike traditional Medicare’s standardized fee schedules, Medicare Advantage plans negotiate their own rates. This means the same service might reimburse at different amounts depending on the plan, making revenue forecasting more challenging.
Wisconsin-Specific Considerations
Wisconsin’s healthcare landscape adds another layer of complexity to SNF billing. The average monthly premium for Medicare Advantage plans in Wisconsin is $24.21 in 2025, making these plans attractive to beneficiaries who may not fully understand the authorization and network requirements.
Your Wisconsin SNF must navigate state-specific regulations alongside federal requirements. ForwardHealth Medicaid programs interact with Medicare coverage, creating situations where coordination of benefits becomes critical for accurate billing.
Common Billing Pitfalls That Hurt Revenue
The complexity of managing dual billing systems creates predictable revenue cycle problems. Authorization denials rank among the most common issues, particularly when facilities fail to obtain proper pre-authorization or submit authorization requests with insufficient documentation.
Coding errors between Medicare Part B and Medicare Advantage submissions lead to claim denials and payment delays. The same service may require different coding approaches depending on the payer, and mixing these up costs money.
Documentation inconsistencies create vulnerabilities during audits. SNF providers face intensified audits from Medicare Administrative Contractors, Recovery Audit Contractors, and Unified Program Integrity Contractors in 2025, making documentation accuracy more critical than ever.
Timely filing failures occur when staff members don’t track varying submission deadlines for different Medicare Advantage plans. Traditional Medicare offers consistent filing timeframes, but Medicare Advantage plans each set their own deadlines.
How Medical Billers and Coders (MBC) Solve SNF Billing Challenges
With over 25 years of industry experience, Medical Billers and Coders (MBC) has developed specialized expertise in SNF revenue cycle management for both Medicare Part B and Medicare Advantage billing. Our dedicated account management approach means you work with the same knowledgeable team that understands your facility’s unique needs and payer mix.
What sets MBC apart in SNF billing:
Our system-agnostic approach means you don’t need to change your existing EMR software to work with us. We integrate seamlessly with your current systems, minimizing disruption while maximizing billing accuracy. This flexibility proves especially valuable for Wisconsin SNFs using regional or facility-specific EMR platforms.
Our specialized SNF billing team maintains up-to-date knowledge of authorization requirements across all 129 Wisconsin Medicare Advantage plans. We track changing requirements, ensuring your claims meet current standards before submission. This proactive approach dramatically reduces denial rates.
We don’t just submit claims—we manage your entire revenue cycle from patient admission through final payment. Our comprehensive denial management services identify patterns in rejections and implement corrective measures that prevent future issues.
The Old A/R Recovery Advantage
Outstanding accounts receivable drain resources and hurt cash flow. MBC’s Old A/R Recovery Services specialize in recovering payments from aged claims that many facilities have written off. Our proven strategies have helped facilities reduce accounts receivable by up to 30%, transforming forgotten claims into recovered revenue.
We analyze your aging A/R, identify recoverable claims, and pursue payment through systematic follow-up and appeals when necessary. For claims denied due to authorization issues, documentation gaps, or coding errors, our team determines the best path to recovery—whether through corrective claim submission, appeals, or payer negotiation.
Taking Control of Your SNF Revenue Cycle
The billing landscape will continue evolving as Medicare Advantage enrollment grows and regulatory scrutiny intensifies. Wisconsin SNFs need revenue cycle partners who understand both the traditional Medicare framework and the complex world of Medicare Advantage billing.
Medical Billers and Coders brings specialized knowledge, proven methodologies, and dedicated support to help your facility maximize reimbursement while minimizing administrative burden. Our industry experience means we’ve solved the billing challenges you’re facing right now—and we’re ready to apply those solutions to your facility.
Don’t let billing complexity leave money on the table. Whether you’re struggling with Medicare Advantage authorization denials, dealing with mounting aged A/R, or simply want to optimize your current billing processes, MBC’s specialized SNF team can help.
Schedule an Audit Today to discover how Medical Billers and Coders can transform your revenue cycle management and recover revenue you didn’t know was possible.
