In healthcare, skilled nursing facilities are crucial in care and rehabilitation services. On the contrary, recent alterations in regulations to boost staffing in America’s skilled nursing facilities and implementation of Patient Driven Payment Model (PDPM) to ease the administrative tasks are creating turmoil. While the PDPM is a big deal in SNF billing, the staffing minimums rule requires three hours of care per patient. This increases the burden on the existing workforce.
Issues like staff shortage and increasing wages are leading to detrimental financial health of the facilities while the excessive pressure of clinical and administrative tasks are leading to staff burnout.
Aftermath of PDPM on SNF Billing
The Centers for Medicare and Medicaid Services (CMS) has implemented the PDPM reimbursement model for SNFs in the United States. It has replaced the Resource Utilization Group system, which primarily relied on volume-based services.
Redefining payment and quality measures: PDPM ensures SNFs prioritize both quality of care and financial sustainability of the facilities. Cost effectiveness maintenance and quality patient care have been aligned with the implementation of PDPM.
Providing tailored services: The regulation considers providing tailored services as per the requirements of each patient. This ensures patient satisfaction and improved outcomes of the rehabilitation and care services.
Improving payments: Without increasing total medical expenditures, PDPM can improve overall skilled nursing facility billing services. By precisely reflecting the care required by each patient with case-mix adjustment components, the regulation ensures adequate reimbursements.
The Setback
PDPM is significant in SNF billing. However, the latest reports by NIC show the market trend is more about managed care and Medicaid compared to traditional Medicare and private pay.
Approximately 33% of Medicare participants are enrolled in managed MA plans and experts expect a rise in the numbers. The Congressional Budget Office is predicting an inclination by 4% each year. This means a significant strain on the skilled nursing facility staff, payment rates and cash flow.
On the other hand, the staffing minimums rule also stipulates at least one registered nurse on duty all the time. In this situation, the facilities are facing issues of staff burnout and reduced revenue.
Consider Outsourcing
The SNF billing and coding services require specific knowledge and skillset to maintain the revenue and quality of the services. Furthermore, you need constant training and education for your staff to maintain their financial wellbeing and quality patient care. The tug-of-war between the modified regulations is increasing the billing issues in SNFs.
To get rid of these challenges, you can consider outsourced billing and coding services. An outsourced RCM company has trained professionals who have knowledge and understanding of current changes. Furthermore, they maintain compliance within the process while using data-driven solutions for your medical billing. The team can work as an extended operational hand for your facility to provide you with an end-to-end solution which will drive your ROI.
Furthermore, you can streamline your healthcare billing and coding process and reduce overhead costs by eliminating the risks of billing errors and claim denials.
