The challenge for skilled nursing facility (SNF) providers today is less about census and more about payer mix. Providers must develop a strong and replicable quality mix—one that, with the application of good marketing strategy and business development techniques, sources desired referrals consistently and dependably.
Q: What are the circumstances that allow us to bill under Medicare Part B?
A: When services are provided in a skilled nursing facility (SNF), Medicare Part B may be billable for residents who have exhausted their Part A benefits or are ineligible for benefit days under Part A, outpatient physical therapy (PT), outpatient occupational therapy (OT), and outpatient speech language pathology (SLP). These therapy services are very common among SNF residents as they rehab from an acute condition such as a stroke or joint replacement. Many SNF residents benefit from short or long term therapy services to help regain movement, strength and activities of daily living. Part B therapy claims are frequently subject to medical review and denial, making it important that the details are billed correctly and that documentation exists to support the services.
A review of the status of the SNF industry involves looking at a patchwork of issues: past, present, and future. To begin to understand these issues, we need to think about the various forces that influence the industry.
External pressures such as lower reimbursement rates and an overall shift in policy by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies, and internal pressures including higher acuity residents, operational decisions, and a competitive environment for residents and employees, have put significant financial and operational pressures on long-term care facility operators.