5 Ways To Avoid Eligibility Issues in a Skilled Nursing Facility (SNF)

Let’s take a closer look at five simple ways to make the billing process work more efficiently for your facility.

5 Ways To Avoid Eligibility Issues in a Skilled Nursing Facility (SNF)

Inefficiency and not having the proper tools and processes in place are some reasons why facilities find themselves in reoccurring billing situations that can have detrimental effects on the continued operation of any Skilled Nursing Facility (SNF). Having to spend time dealing with account administration, handling rejected claims and similar demanding tasks often takes attention and resources away from more critical tasks. With proper eligibility verification tools, it is possible to minimize the time spent on billing errors and, in many cases, avoid them altogether. Let us take a closer look at five simple ways to make the billing process work more efficiently for your facility. 

1. Make the burden of administration as small as possible

It might seem like something that is easier said than done. However, even minor changes in existing administrative routines, such as a tool that gives you the power to check patients’ personal information and conduct the first health eligibility verification automatically, can have a significant impact on the time spent verifying coverage. Long gone are the days when the only option available is to manually double-check every piece of information.  Many online options enable you to automatically verify new patients’ information and keep yourself updated on the changes in coverage of existing residents. One of the benefits of automation is that you and your employees are going to save a lot of time on routine tasks involving billing, coverage, and claims.  

Make use of available online tools to deal with patient information as efficiently as possible. Take the time to double-check coverage before submitting a claim. 

2. Make use of Claims Management Tools that easily integrate with eligibility verifications.

Having existing routines for verifying the information and insurance benefits is vital. It will safeguard you against rejected payments and precarious resident situations. It is best to perform health insurance eligibility verification as soon as you receive notice of a potential resident since there are many cases where a previously relevant coverage is no longer applicable, for example, Leave of Absence days (more information on this case is available here.

Therefore, you want to make sure to get as much information as possible and avoid making coverage assumptions. 

Minimize the risk of delayed or problematic billing by having effective routines for verifying coverage. 

3. Don’t underestimate the importance of timely verification checks.

Even though it is never an easy task to inform a prospective resident about the lack of coverage, it is often necessary. By having regular routines when it comes to health insurance eligibility verification and the need to inform all interested parties of its results, the facility staff will be able to face problems upfront and avoid the extra work involved in retroactively dealing with issues that could have been avoided. Incorrect insurance information may lead to a claim denial  

Having all the information about a patient’s coverage at intake lays the foundation for timely payment. 

4. Always stay up to date on rules and regulations

We are living in times when a small change in current regulations can have a significant impact on claims. Your claims management tool should give you updated information in real-time to ensure that you have constant visibility on ongoing coverage changes. It is also essential to make sure that there is as little discrepancy as possible between the date of service and the actual claim. 

Staying up to date on insurance coverage rules and regulations can also provide a competitive advantage over other healthcare organizations that do not follow the regulations closely and do not spot changes immediately. This can help you attract more patients who will be satisfied with your level of service and bring more revenue to the business. 

By making sure that you are on top of regulations, rules, and requirements, you avoid having to face unnecessary denials or rejections. 

5. Pinpoint the common reasons for rejections and identify them proactively

By using modern automated healthcare solutions, including health insurance eligibility verification software, you will be able to identify recurring issues and avoid spending more time than necessary on situations that ultimately will lead to rejection. Having a viable RCM solution helps you identify recurring problems using reason code reporting. Your team should create a plan that removes these roadblocks and improves cash flow. .

Identifying your top reason codes for rejections and denials

  • Review and organize data: Collect and review data on all your claims that have been rejected or denied by insurance providers. This information is usually available in your billing system or through ERA or EFT) reports. Organize this data collected into categories based on the reason for rejection. 
  • Evaluate reasons and develop a plan: Evaluate the reason codes for each denial and identify the most common ones. This will help you to identify which areas of your billing process need the most improvement. Develop a plan to address these reasons, e.g., staff training, improving your eligibility verification process, or making changes to your billing procedures. 
  • Act and monitor the progress: Implement the changes you have identified in your plan (e.g., purchase new billing software). Monitor the claim data to see if the changes have made a positive impact 

What if a claim is rejected?  

Accept the situation and focus on solving the issue. Double-check the available information in order to identify what caused the rejection and, if possible, file an appeal. Then focus on building a system for identifying common threads in rejections in order to avoid them in the future. 

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