Nursing home billing is creating a bill for the services provided to nursing home residents. It includes both basic and additional services like:
- Physical therapy
- Speech therapy
- Occupational therapy
There are several key aspects of nursing home billing which include:
- Accurate coding: Using appropriate codes to represent services (e.g., CPT and HCPCPS codes) for billing.
- Claim submission: Preparing and submitting claims to the payers.
- Payment processing: Tracking as well as managing payments received from the insurance companies.
- Denial management: Addressing and resolving claim denials.
- Regulatory compliance: Complying with the rules set by the insurance providers.
- Revenue cycle management: Optimizing the whole billing process and finally collecting payments.
Now, several regulations have come into existence that are affecting the nursing home companies. Let’s learn about these regulations:
Latest Regulations for Nursing Home Billing
SNF Consolidated Billing Updates
CMS has revised the list of HCPCS codes subject to SMF consolidated billing, which is effective from 1st April 2025 onwards. These updates play an important role as they determine what services need to be bundled under the SNF and which services can be billed separately.
- Additions: A total of 25 new HCPCS codes have been added. It includes chemotherapy service, blood clotting factors, and mammography settings. Moreover, Colorectal screening services are also included in this process.
- Deletions: 30 HCPCS codes have been deleted which include previously covering chemotherapy drugs and vaccine administration. Hence, it signals a reclassification of responsibilities between SNFs and external providers.
These changes directly affect the SNF billing departments. It requires regular system updates and staff retraining to avoid rejections and claim denials.
HCPCS code enrollment
CMS is tightening enforcement for the HCPCS coding requirements within the SNF billing structure.
- Adjustments are being made to specific codes tied to radiation therapy, chemotherapy, and end-stage renal diseases.
- Remote therapeutic monitoring and colorectal screenings have been emphasized under updated coding compliance frameworks.
Hence, these updates have been designed to increase SNF billing accuracy and reduce improper Medicare payments. The SNFs must confirm that the services billed under Part B are excluded from the consolidated billing requirements.
CPT Code Set Revisions
The AMA has issued the 2025 CPT code set, including extensive changes affecting nursing home billing.
- 270 new codes: These address emerging services which include remote patient monitoring, genomic testing, and advanced diagnostic procedures.
- 112 deletions: Around 112 outdated or infrequently used procedures have been removed to simplify billing workflow.
- 38 revisions: Definitions and usage instructions for existing codes have been clarified to reduce errors.
As healthcare providers perform almost all the operations, that’s why it becomes difficult for them to have knowledge of the updated regulations. That is where the nursing home billing company comes in with their dedicated experts.
How Does the Nursing Home Billing Company Help?
- Complying with the updated regulations: Their dedicated experts know all the updated CPT, ICD, and HCPCS codes to streamline the claim submission process.
- Getting helps with prior authorization: These experts verify patient insurance eligibility, collect important patient documentation, and then submit PA requests to make sure no claim denial occurs.
- They are highly cost-effective: The in-house billing team comes with a high cost. It’s because you have to train them and also buy expensive office space for them. On the contrary, the billing experts don’t need any of these which becomes one of the main reasons to hire them.
Final Thoughts
As the healthcare resources perform almost all the healthcare operations, that’s why they can’t give enough time to improve patient care. That’s where the nursing home billing company comes into the picture. Their dedicated experts know all the complex coding procedures. Apart from that, these experts have in-depth knowledge of streamlining the prior authorization procedure. Hence, with their help, you can create an accurate billing process at a lesser cost.
Read more: Versatile Medical Billing Services: The Key To A Blissful Clinical Practice
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