Proven Strategies to Overcome Nursing Home Billing Obstacles

Consistent staffing shortages in nursing home billing offices are leading to billing lapses  

and many bad debts. This has become a major concern for the providers as it is necessary to maintain a stable revenue stream to ensure the nursing home's functionality.   

Unfortunately, if your nursing home billing efforts are not optimized for success, generating revenue will be difficult.   

Billing obstacles can harm your nursing home residents, whether they result in late payments, denials, patient complaints, or even missed deadlines. Obstacles elimination is vital for your organization’s bottom line, so consider the most prevalent nursing home billing obstacles to develop strategies to prevent revenue loss.

Pitfalls in Nursing Home Billing 

• Regulatory compliance
• Lack of staff expertise and knowledge  
• Outdated billing system
• Lack of denial management system  
• Poor financial management

The director of Financial Services for Quality Healthcare Resources noted that staffing shortages are becoming increasingly common in departments where they were previously uncommon. Many experienced billing professionals are retiring or leaving due to a preference for remote work, and providers are struggling to find qualified individuals with the expertise needed to navigate the complex payer landscape, particularly with managed care.  

Additionally, the knowledge transfer process is inadequate when it comes to nursing home billing services. As the people leave the job, the remaining often do not have the knowledge of billing and coding regulations and guidelines.   

How to Handle Billing Obstacles in Nursing Homes  

A poor billing practice leads to delayed reimbursements and reduced revenue. Here are some of the strategies you can implement to eliminate the challenges of nursing home billing-  

Review charge description management

Suspense times must be clearly stated in rules and regulations and effectively communicated to departments by nursing home facilities to improve reimbursement collections. Suspense times are strict deadlines skilled care institutions must stick to when entering accurate, audit-proof, and compliant charges for every therapy provided.

The unpaid cash receivables and cash flow of the facility may suffer with each day that charges are not submitted, and suspense time is lost. Because of this, a detailed analysis of the charge description manager (CDM) is necessary to ensure that facilities accurately collect all funds and do not leave any unclaimed. 

Meet filing deadlines   

Several facilities have unmonitored and inefficient systems. As a result, either they do not file initial claims or do not reply to the claim appeals.   

Claim submission guidelines vary from insurer to insurer, and it is essential to stay updated about the same. Every payor has different claim submission deadlines and if you do not submit the same within it, you will face claim delays and denials.   

Denial management  

Monitoring, tracking, follow-up, and handling the rejections- all are part of the efficient denial management system. Identifying the cause and patterns of denial is essential to prevent it. A consistent follow-up procedure allows you to determine if a claim has been accepted or rejected.   

Or You Can Outsource  

If the thought of outsourcing has crossed your mind, you need to identify some factors within your facility. There are some warning signs that you should look for in your nursing home facility-  

• High denial rates  
• Reduced revenue  
• Staff burnout
• Errors in billing and coding operations

If one or more signs are present in your facility, then it is time to outsource your nursing home revenue cycle management.