How SNF Billing Company Helps Reduce Duplicate Claim Errors

 

Many a times it happens that a resident's coverage changes even while the care continues in the same skilled nursing facility. Factoring in this change is crucial and something that a skilled nursing facility billing company can help a practice with.   

The right SNF billing partner can be helpful in identifying midway changes such as the beginning of the Medicare advantage enrolment. Or that Medicaid eligibility gets updated. Therefore, a lot can happen during a single stay. This is why duplicates are so rampant in SNF revenue cycle management. Follow along to see how professional SNF billing services can help practices steer clear of duplicate claims across payers.   

What Counts as a Duplicate Claim Across Payers?  

A duplicate claim is a claim that gets submitted more than once. This might seem like a small problem, but it is far from that. Duplicate claims can derail the billing entirety of the SNF billing operation. This is because such a blunder can result in higher scrutiny.   

Then again, understanding what entails as a duplicate claim is also important. A legitimate secondary claim for a single stay cannot be termed as a duplicate claim in any way. As per the regulation, the primary claim is handled first and then comes the secondary one. Once the primary payer is done with the claim, the secondary takes over after considering their share in the payment.   

But a duplicate claim is a claim that has been submitted twice. This is why; more and more providers have decided to outsource skilled nursing facility billing to professional RCM experts. They can step right up and help skilled nursing facilities handle its billing operation with a heightened sense of clarity and precision.   

Why Skilled Nursing Facilities Face Payer-Overlap Risk  

One of the biggest reasons behind SNF billing claim overlapping is because how complex these claims are. It is very common for an SNF Billing claim to contain several service lines involving multiple practitioners across multiple disciplines.   

This can create areas where information simply gets lost. As a result, creating overlapping risks can lead to several grave consequences such as a financial escalation or a rigorous scrutiny. Both of which have their own impact.  Here is a detailed look at why SNFs face payers overlap risks.   

1) Coverage changes during an active stay  

One of the most common reasons behind informational overlapping is the change of coverage. A resident might move from Original Medicare to a Medicare Advantage plan. In such cases, it is the onus of the SNF billing team to take over and record the necessary changes. Otherwise, the duplicate claim might keep existing in the system, eventually leading to a financial escalation  

2) Outside suppliers and unshared stay information  

It is quite common for SNFs to partner with external providers like laboratory, imaging groups, ambulance providers, etc. This creates a problem area for SNFs. Therefore, SNF billing teams tend to create a system where external claims are routed through the facility's claim only. As a result, creating a cohesive bill that factors in the external as well as the internal service lines.   

3) Late charges, split claims, and automated retries  

Another thing that happens is quite common in SNF claims is an automated duplication. Advent of AI has pushed more and more providers towards automated billing models. These billing models are great for expediting the flow of work, but they do create the risk of duplication. AI systems can enter a single detail more than once if it fails to register the first try as a successful one. In these cases, the duplicate entry stays inside the workflow until it is flagged by payers. At this point, it becomes too late to address.   

4) Use Consolidated Billing as a Core Safeguard  

One of the easiest safeguards to handle SNF billing discrepancies includes consolidated billing. A single consolidated claim prevents billers from creating separate claims for specific service lines. Here is how a consolidated billing approach can help with SNF billing: 

5) Confirm benefit status for each date of service  

One of the most important details about skilled nursing facility billing is that the admission-date and eligibility check can be redundant later on. This is because a lot of things might transpire. The resident might change insurance, the stay coverage can exhaust or there could be new clinical development. Hence, checking the benefit status for each date of service is the way to proceed.  

6) Validate codes and exclusions against current CMS files  

Not every service line can be bundled into a single unit. In fact, regulatory bodies like the CMS have mandated separate billing workflows for certain defined categories. These generally include professional physician services, ambulance services, and customized prosthetic devices. Therefore, the coding needs to be impeccable and must reflect this mandate.    

7) Coordinate Medicare, Medicare Advantage, and Medicaid Correctly  

A single SNF claim might have more than one payer. Therefore, providers need to be diligent when handling such cases. It is advisable to keep payer orders separate from service billing responsibility. This allays confusion and helps the provider create more accurate claims.  

This rings true for Medicare as well as Medicaid. The biller needs to handle these paying entities separately. When the coverage shifts, the claim needs to be divided as per the date of change.  

Resolve all the Duplicate Claims without Creating another One  

One of the vital things that can help avoid such confusion is being cognizant of the situation. This not only helps these long team care providers with duplicate detail entry but also a smooth billing operation. And this can start by comparing the original claim details. As if any duplicate details are repeated during the scrutiny, action can be taken immediately. 

Being cognizant is one of the most important things that can help providers to steer clear of duplicate detail entry. This is why dental billing experts tend to begin their task by clearly comparing the original claim number, date of submission, payer response, service lines, and payment.  

If the second entry repeats these unique elements, then there is a high chance that a duplicate claim has been created. In which case, taking rectifying actions is necessary. This might seem like too much work, but it does help providers to steer clear of billing errors.   

However, the biggest and most important means to avoid this phenomenon is to hire a professional skilled nursing billing partner. The right partner can not only help with claim submission but also provide ancillary support to ensure a smoother billing operation.  

How outsourcing your skilled nursing facility billing can support: 

It is no secret that preventing any kind of duplicate claims takes a consistent approach and an experienced expert. With all the coverage changes, payer responsibilities and payer records such an expert can help you out easily with your submission and avoid payment delays while you invest your time in patient care. 

Especially for facilities stretched thin, outsourcing to a skilled nursing billing company is one of the practical options. With the right partner by your side, you have more time to support the residents in the facility and less time untangling billing issues.