Under the Prospective Payment System (PPS), Skilled Nursing Facilities (SNFs) receive a fixed daily payment from Medicare Part A intended to cover all patient services during their stay. With the implementation of consolidated billing, all services provided are bundled into a single reimbursement package.

Key billing requirements include:

• Consolidated Billing Compliance: SNFs must submit all claims collectively as part of the consolidated billing process under PPS.
• Accurate Service Identification: Correctly distinguishing which services fall under Medicare Part A versus Part B is essential for proper billing.
• Balancing Fixed Payments and Actual Costs: The fixed per diem payment may not fully cover the varying levels of care and services required, potentially leading to gaps between reimbursement and costs.

We recognize that each Skilled Nursing Facility has distinct operational requirements. To accommodate these differences, Gedeihen Healthcare offers a range of flexible and scalable service models tailored to your facility’s needs.

Our service options include:

• In-House Service Model: Facilities can recruit qualified billers and coders through Gedeihen Healthcare’s job portal to manage billing internally.
• Outsourced Billing Model: For facilities without an in-house team, Gedeihen Healthcare provides comprehensive outsourced billing services, covering everything from insurance verification to post-submission follow-up.
• Revenue Cycle Management (RCM) Consulting: Gedeihen Healthcare assists in identifying revenue leakage points, optimizing workflows, and recommending software enhancements or staff training to improve financial performance.

Partnering with a specialized Skilled Nursing Facility billing service offers numerous benefits that positively impact your revenue and reduce administrative workload.

Advantages of outsourcing include:

• Reduced Claim Rejection Rates: Expert billers ensure accurate claim processing, minimizing rejections and accelerating reimbursements.
• Improved Revenue Cycle Efficiency: Optimized billing workflows enable timely and efficient claim handling.
• Compliance Assurance: Billing processes are maintained in full compliance with Medicare and Medicaid regulations, lowering the risk of penalties.