As skilled nursing facilities (SNFs) across the country try to recover from the ongoing pandemic, many continue to face uphill battles to regain control of their balance sheet. While constantly struggling to meet occupancy rates and overcome staffing challenges, organizations must find the time to address revenue leakage. Leakage can occur and go unnoticed in the beginning of a SNF’s revenue cycle, or at any point until payment of the final outstanding invoice.
When SNFs employ best practices to manage their revenue cycle with the same level of care they provide to their residents, they will be better positioned to prevent unintentional losses and maximize revenue cycle efficiency.
Best Practice #1: Focus on Front-End Tasks
One thing that cannot be stressed enough is the importance of data collection when a resident record is first keyed into the system. Ensure your front-end admissions staff is taking the time to enter accurate information so records are as clean as possible. When errors are made during the inquiry/intake process, it can disrupt a claim’s process and require additional facility resources that may not be readily available. To prevent unnecessary rejections from piling up, providers must:
Collect accurate demographics for the resident
Verify the resident’s insurance eligibility
Determine and collect resident’s financial responsibility
Best Practice #2: Establish an Authorization Tracking Tool
Prior authorizations from insurance providers are a big part of the intake process as it relates to managed care and commercial payers. SNFs need to verify which payers require pre-authorization, recertification, or reauthorization for certain services/procedures, then document each request and approval, and finally, check that accurate and complete information is submitted in the final claim form. Regular reviews of these processes should also be conducted to account for any payer rule changes and to help identify issues surrounding denials management. To streamline authorization processes, SNFs should:
Assign authorization responsibility to an individual who understands the clinical process, such as a nursing staff member
Obtain written confirmation of the authorization and store in the electronic medical record (EMR) or somewhere easily accessible
Utilize software or another tracking system to record which managed care payers mandate authorizations, and use automated reminders to keep tasks on track
Best Practice #3: Establish a Triple Check Process
Many “bad outcomes” of a claim could easily be avoided if a Triple Check Process had been utilized. An internal audit process widely used by SNFs for Medicare compliance, this system relies on a team to review each claim for accuracy before it is submitted for reimbursement. These individuals typically include a minimum data set (MDS) coordinator, financial administrator, director of nursing, social workers, and therapists. Claims must be reviewed for matching information across all relevant forms, including insurance authorization, resident medical records, hospital transfer records, and more. Your Triple Check Process should include:
Clearly defined responsibilities for each person performing the audit
Structured, well-documented monthly meetings that follow a checklist
Initial and ongoing training for staff to help reduce errors
Best Practice #4: Analyze & React to Your Data
Management should review claims data on a monthly or daily basis, depending on the size of an organization and the state of its finances. SNFs with smaller margins that are more concerned with meeting operational goals each month would benefit from a daily check-in. The sooner rejections and denials are identified, analyzed, and addressed, the quicker they can be resolved and reimbursed. SNFs should also monitor performance, particularly during staffing changes, as this can have a significant impact on revenue cycle efficiency. SNFs should prepare to:
Establish appropriate benchmarks for your organizational needs
Identify process gaps and opportunities for improvement in system configuration or staff training
Adjust internal resources or consider outsourcing to better meet expectations
When the best practices outlined above are established and carefully followed, SNFs will be better positioned to predict and optimize revenue. From the very first contact with a resident to the final payment, the entire revenue cycle will become more streamlined for everyone involved. Less time and resources will be required to manage claim clean-up, and staff will be free to focus on what they care about most – the residents. For more information on how to implement RCM best practices in your SNF, contact Richter Healthcare Consultants online or call us at 866.806.0799.