How MDS Accuracy Shapes Skilled Nursing Facility Billing Results 

The general definition of MDS or Minimum Data Set is more often explained as nothing more than a clinical assessment. Then again, this definition is only one part of the story. Documentation accuracy of details such as codes, interview notes, etc., play another major role in financial homeostasis of a skilled nursing facility.

This is why; skilled nursing facility billing is not a process that begins when a biller sits down with the claim. It begins much earlier, during the initial visit where a patient and their condition is recorded. This is why some of the most established SNF billing outsourcing services prioritize this front-end part of the billing so that rest of the process remains pressure free.

As per the PDPM regulation, a Medicare resident's care is assessed five crucial components. These components primarily include as follows:

The challenging part of the whole thing is that each of these components comes with their own set of requirements. Therefore, it is imperative that the billing team employed by a skilled nursing facility is capable enough to handle this situation. Otherwise, even a missing condition detail or unsupported diagnosis can alter the payment classification that is attached to the stay.

This can not only affect the billing but also the rest of the operation as well. In other words, if a SNF provider has too much halted revenue due to denial or delay, it can slowly start facing a cash crunch. Eventually, the provider can even face difficulty in keeping the lights on or paying salaries.

As a result, it is safe to say that skilled nursing facility billing solutions are more than responsible for the clerical side of maintaining a healthcare facility. They act as financial guardians that are charged with the task ensuring that claims pass through seamlessly, and with the least amount of friction.

As it has been stated earlier, the revenue path for a skilled nursing facility does not begin after the care has been administered. It is a simultaneous process that runs parallelly with the clinical side of things.

Details such as nursing notes, therapy records, medication administration records, dietary documentation, physician information, wound records, and other such details must be recorded in real time, and with heightened accuracy.

After which the MDS coordinator then applies the relevant Resident Assessment Instrument instruction to complete the assessment. The completed assessment is then used to generate a classification as per the Health Insurance Prospective Payment System code that is used in Medicare billing.

It is very important for the MDS team to communicate well with the hired skilled nursing facility billing service to match the assessment with the claim. Failure to do so can result in inconsistencies passing through the matrix.

The most blatant and visible consequences of an inaccurate assessment is an incorrect reimbursement amount, even though the broader costing of this is much more expansive. For instance, an inaccurate assessment can cause situations like claim holdup, repeated correction of a claim, and additional rework. All of which can put unnecessary pressure on the skilled nursing facility billing team.

Underpayment, on the other hand, can be another major challenge that providers might face. The reason why underpayment is such an issue is that most modern RCM denial management systems are calibrated to only detect failure of payment. The solution to this problem is that skilled nursing facility billing services must include component-level monitoring. This helps organizations to have a better sense of clarity on what is going on.

Last but not the least is overpayment. Even though overpayment might not sound like a bad thing. However, if this is left unchecked or unreported, a facility can become liable to lawsuits and regulatory actions. This is why most SNF billing services tend to report overpayment right away in order to avoid any sort of legal hijinks.

The biggest mark of a reliable skilled nursing facility billing is not in the kind of tool it uses. In reality, the true mark of a billing team's excellence is how it builds and handles the revenue workflow. Here is a brisk rundown of what a provider needs in order to build an accuracy-controlled revenue workflow:

A structure pre-submission preview is not something to sneer at. A concise review addressing all the sensitive points in the SNF revenue cycle management is one of the smartest ways to address big problems that can derail the financial engine.

The preview must be direct and should ask two plain questions such as: Is the assessment complete with all the necessary details including the care and condition of the patient? Can every material entry be supported using the submitted record? Therefore, allowing SNF billing outsourcing services to have better insight.

Errors are best handled earlier, instead of addressing them after payment or acceptance. Therefore, the billing support must have a proper plan of actions for handling and finding out the necessary errors. Another important detail is to not use a one-size fits all fix that does not factor in the finer nuances of the practice and the nature of the error.

Once the assessment is over, the team can then move on to corrective actions. Even in the corrective stage, the team must examine the cause behind the said problem. Some of the possible causes in such a setting could include confusing template, outdated software logic, incomplete training, etc. The right practice is the one that understands the problem and create a plan of action to address it once and for all so that it does not get repeated.

A provider must never forget that accurate assessment of a claim is not entirely a responsibility of the MDS coordinator. A skilled nursing facility billing is equally responsible as well.

Therefore, it is high time that providers bring in the right and most professional outsourced billing services to handle this situation. Otherwise, it can continually face revenue cycle issues that can really put a dent on a practice's financial homeostasis.