By 2050 the long term care facility billing market is expected to jump to 88 million. As according to a recent survey, seven out of 10 are seen undergoing long term care facility services. With the increase in the older population in the coming years, the majority of the population will be headed toward such care—through a nursing home or assisted living facility. The current definition of long term care facility includes services provided in the home by family members or paid caregivers. Adult day-care is also considered a form of long-term care. In fact, the nursing home facility can also be partially considered as a long term care facility.
However, today due to the lack of resources, skilled billers and certified coders, the long term care facilities today are facing many challenges resulting in financial instability.
Challenges in nursing home billing:
With the ever changing rules and rising healthcare costs of long term care, a lot of practices are finding it really difficult to conduct operational functions seamlessly.
Moreover, the understanding of the claims forms ( UB-04 ) is another complicated affair.
Common billing and coding errors in long term care facility billing:
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Missing or incorrect information during the billing process – at times missing data of the patient, mistake in the demographics information, missing of the physician’s signature prior to billing all end up as billing errors. This later results in delayed reimbursement, so accuracy is the key.
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Coding errors or Upcoding – it happens when incorporating wrong codes with one another. As all the services in long term care have a specific code attached to them which is why even a single mistake can result in coding errors.
- Duplicate billing – This refers to billing a patient more than once for the same service
- Pending AR – Pending A/R is a huge trouble area for long term care facility that does not have adequate staffing. A fine blend of resources that are equipped to handle all pre and post long term care billing requirements in the right manner to secure maximum reimbursements is always essential.
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Problems in the verification – most of the time the insurance-related information is improper or not update of the patient, resulting in problems.
Thus, revised and updated information should be communicated to the emergency room medical billing organization.
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Improper claims management process – A very minute error can result in claim rejection and denials, which results in deterioration in cash flow and profit of a healthcare practice.
The Sunknowledge approach:
With a complete understanding of the industry mandates and other billing regulations, new codes, claims forms (UB – 04); Sunknowledge Services Inc, today is the leading RCM solution serving many largest names in the industry. With complete proficiency in working on different billing software and being versatile in pursuing claims with different payers, our experts further maintain guidelines followed by different payers for authorization, timely filing process, case rates, per diem rates, DRG, etc.
Offering a streamlined process that facilitates accurate billing, our experts further ensures regular audit on all claims. Ensuring complete operational transparency, our experts with stringent checks and balances not only maintain clinical compliance audits but further ensure a 99.9% accuracy rate in the complete process.
Working for more than a decade, we today focus more on patient care management, ensuring a better billing operation with improved ROI.
Reducing the risk of your long term care facility billing and coding errors, partnering with us will help you with a streamlined billing process and more collections.
Sunknowledge Services Inc. – an ISO 27001:2022 certified, American-owned & operated company, headquartered in New York City – is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain.
