Post-acute billing · Skilled nursing
In an SNF the clinical record is the invoice.
247 Medical Billing Services runs skilled nursing facility billing services that protect every Part A day, Medicare Advantage stay, and Medicaid dollar across your revenue cycle — MDS-to-HIPPS accuracy, consolidated billing, and aggressive appeals. Serving freestanding SNFs, hospital-based skilled units, and multi-facility operators since 2005, we pair a dedicated account manager and a free 360° reporting dashboard with HIPAA-compliant, SOC 2 Type II operations.
Days that felt like inpatient to the resident — but never counted toward the three
One MDS assessment fixes the case-mix code that prices an entire Part A stay, nearly everything you deliver is folded into a single per-diem you cannot itemize, and a rising share of your days belong to Medicare Advantage plans that authorize the admission, drive the length of stay down, and cut the level of care mid-stay.
5-character HIPPS
The code that prices the PDPM per-diem for the whole stay. We tie the HIPPS on the claim back to the code the MDS generated, so the payment code always matches the record.
The variable per-diem front-loads the money
Getting paid to the true value of the care means managing every link in that chain — from the qualifying-stay check at intake to the HIPPS code on the claim to the appeal that reverses a downgrade. Codes and claim mechanics are noted here for precision:
| Where money is won or lost | What it is | What we manage |
|---|---|---|
| The MDS-to-HIPPS chain | The MDS assessment generates the 5-character HIPPS code that prices the PDPM per-diem for the whole stay | Accurate MDS coding, a deliberate assessment reference date, and a HIPPS tie-out so the code on the claim equals the code the MDS produced |
| The Part A coverage gate | Qualifying three-day inpatient stay, daily skilled need, physician certification, benefit-period days | A verified qualifying stay with no observation days, the certification and recertification chain, and correct occurrence and value coding of the stay dates |
| PDPM classification | Six components, the primary diagnosis in item I0020B mapped to a clinical category, and the variable per-diem taper | Diagnosis validated against the current mapping so it never returns to provider, with acuity captured across nursing and the non-therapy ancillary component |
| Consolidated billing | The bundled per-diem plus the annually updated list of separately billable excluded services | Correct bundling, carve-out of genuinely excluded services, and reconciliation against the current-year exclusion file at both claim and vendor-payment |
| The institutional claim | The UB-04 / 837I with HIPPS on the 0022 revenue line, room and board on the 012x series, ancillaries on their own revenue codes | The full revenue-code set, occurrence and value codes, and coinsurance built correctly for every payer |
Clean claims go out within 24 hours, so cash that used to age in a work queue starts landing in the bank instead:
A nursing-home claim is not an oversized office visit, and pricing it like one leaks money at every joint. Each moving part is a place revenue quietly disappears:
A clinical assessment sets the price. Under the Patient-Driven Payment Model (PDPM), the per-diem is the sum of six components: physical therapy, occupational therapy, speech, nursing, non-therapy ancillary, and a flat non-case-mix piece. Each rides on the MDS. Miscode the MDS and you either leave earned acuity on the table or invite a takeback. The MDS-coordinator-to-biller handoff is where payment accuracy lives or dies.
The gate to Part A is unforgiving. Coverage requires a qualifying three-day inpatient hospital stay, a daily skilled need, physician certification, and care inside the benefit period. The biggest single technical-denial cause is the observation-day trap — days that feel like inpatient to the resident but never counted toward the three.
Almost everything is bundled. Under consolidated billing the SNF has to bill for virtually all services furnished to a Part A resident and pay outside suppliers itself. Bill an excluded service into the per-diem, or let a vendor bill Medicare for something that should have been bundled, and you have a compliance finding, not merely a coding slip.
The variable per-diem front-loads the money. Therapy components taper after day 20, and the non-therapy ancillary component pays triple for the first three days. Setting the assessment reference date and the classification right at admission is worth real dollars across the whole stay.
Pays the strongest short-stay per-diem but is a shrinking share of days — and effectively subsidises everything else in the building.
Supplies the bulk of days at below-cost rates, with a patient-liability mechanic that must be reconciled monthly.
Now the majority of the Medicare book. Pays contracted rates, demands prior authorization and concurrent review, and issues the level-of-care downgrade that is the signature SNF denial.
Because the all-payer margin in this setting runs near zero and the non-Medicare book runs below cost, recovering even a few points of leakage separates a facility that reinvests from one that merely survives.
One certified team carries an SNF claim from admission to zero balance, rather than splitting it across vendors who hand work back and forth:
The qualifying three-day stay confirmed against the hospital record, benefit-period days remaining, dual-eligible and secondary status captured, and the Medicare Advantage prior authorization secured through our verification workflow before the admission rather than after the denial.
The assessment reviewed for coding accuracy, the assessment reference date set to protect the stay, the primary diagnosis checked so it maps cleanly, and the claim HIPPS tied back to the HIPPS the MDS generated.
The bundle managed correctly, excluded services carved out against the current exclusion file, and vendor invoices matched so nothing is double-billed or wrongly separated.
Admit authorization captured, concurrent review filed, authorized-through dates tracked, the NOMNC issued on time, and level-of-care downgrades appealed to root cause by our denial-recovery team because most do not survive a real appeal.
Aged claims pursued across Medicare, Medicare Advantage, Medicaid and managed Medicaid, crossover to secondary payers, day 21–100 coinsurance billed correctly, and Medicaid patient liability reconciled every month.
The end-to-end revenue cycle from intake to reconciled balance, or the coding layer alone, run by coders who genuinely know SNF.
If you would rather keep skilled nursing facility billing and coding services under one roof, that is precisely our model — certified coders and billers on one team, reading one record, instead of shipping claims between two companies.
Skilled nursing is the setting where outsourcing pays off fastest, because no other book of business forces a single in-house team to master this many disciplines at once: PDPM case-mix logic, consolidated-billing exclusions, Medicare Advantage utilization management, and Medicaid patient-liability reconciliation.
When a seasoned MDS-savvy biller resigns, the case-mix knowledge often walks out with them, and a lone coder cannot cover PDPM, the exclusion file, and MA appeals with equal depth. On margins this thin, one uncovered specialty is enough to sink the month.
Outsourcing to a skilled nursing facility billing services company converts that fixed, fragile payroll into a predictable transaction-based cost that scales bed by bed and building by building — while a bench of certified specialists, not one irreplaceable hire, guards your Medicare margin. You keep clinical care and census in-house, where they belong, and hand off the case-mix accuracy, authorization chases, appeals clock, and monthly Medicaid reconciliation to a team that does only this.
Revenue review
We'll put a dollar figure on what your denied Part A days, lost Medicare Advantage stays, and aged A/R are actually costing.
An SNF billing specialist will reach out within one business day.
An SNF billing specialist will reach out within one business day.
Bringing us on is not hiring a general biller who happens to accept nursing-home claims. It is hiring specialists who already know where post-acute revenue leaks:
The assessment is read against the chart before anything is billed, so earned acuity is captured and nothing is claimed the record cannot carry.
The code on the claim is matched back to the code the MDS produced, so the payment code and the record never diverge.
The authorisation, the physician certification, and the recertification chain are all confirmed before the claim leaves.
That is a real Triple-Check — clinical, financial and compliance lenses verifying each Medicare claim together. It is the single most effective SNF billing control, and most facilities do it poorly or skip it.
A generalist learns skilled nursing on your claims. We arrive already fluent in it, and the gap shows up on the remittance:
Most skilled nursing losses trace to the same handful of failure points — the five things SNF claims are denied for, plus the audit stack that follows outlier billing. Codes are noted here for precision:
No qualifying three-day inpatient stay / observation days counted as inpatient
Technical Part A denial
We verify inpatient status against the hospital record at intake and confirm the 30-day window before we bill
Invalid primary diagnosis in MDS item I0020B or a claim HIPPS that does not match the MDS
Return-to-provider and case-mix denial
We validate that the diagnosis maps to a PDPM category and tie the claim HIPPS to the MDS in Triple-Check
Medicare Advantage stay billed as skilled after a level-of-care downgrade
Level-of-care / medical-necessity denial
We document the daily skilled need, manage concurrent review, and appeal downgrades fast — most are overturned
Missing or late physician certification / recertification
Certification-defect denial
We run a certification calendar and hold billing until the cert and recert chain is signed and timely
Medicaid patient liability on the claim does not match the recorded amount
Patient-liability denial (RARC N861)
We reconcile collected patient liability to the state record every month before the claim goes out
Additional Documentation Request (ADR) missed, or PASRR not completed before a Medicaid admission
Automatic denial and audit exposure (TPE / RAC / UPIC)
We own the ADR calendar to the deadline and gate billing on the PASRR screen at intake
Every one of these is preventable before submission rather than argued after the fact. Behind them sits the full CMS contractor stack — Targeted Probe and Educate, Recovery Audit and program-integrity contractors, CERT and the SMRC — plus your PEPPER outlier report and the VBP and QRP programs that put payment at risk on quality data. We bill in a way that keeps you off those radars and answers them cleanly when they arrive. As a dedicated skilled nursing facility billing services company, we treat each of these details as routine rather than a special case.
The rules shift with the setting and the payer mix, and we bill each to the detail it demands:
The full PDPM per-diem, the Medicaid custodial book, and the Medicare Advantage caseload under one revenue cycle, where case-mix accuracy and denial control decide the month.
What decides the moneyCase-mix accuracy and denial control
Post-acute days billed on the institutional claim alongside the parent organization, where the qualifying stay and level-of-care documentation drive clean payment.
What decides the moneyThe qualifying stay and level of care
Standardized MDS-to-HIPPS integrity, Triple-Check, and denial analytics across a portfolio, with one dashboard over every building.
What decides the moneyStandardisation across the portfolio
Campuses with skilled beds that move residents between private pay, Medicare, and the Medicaid spend-down, where clean statements and correct payer sequencing matter as much as the skilled claim.
What decides the moneyCorrect payer sequencing
Where physician and practitioner work is excluded from consolidated billing and billed separately; see our related physician and practitioner billing services for that side of the practice.
What decides the moneyWhat is excluded, billed separately
Changing billers should never mean a stall in cash, and with us it doesn't.
We work inside the clinical and billing systems you already run — PointClickCare, MatrixCare, and the platforms your MDS and business-office teams use daily.
Credentialing and payer-enrollment review run in parallel while your claims keep going out the door, and a named account manager leads the transition from day one.
Most facilities are fully live within a few weeks.
The denial drop and the faster A/R appear in the first cycles, not a quarter later.
More Part A days paid at full value, and downgrades reversed instead of eaten.
Every HIPPS code tied cleanly to the record — that is what medical billing for a Skilled Nursing Facility should deliver, and it is what our team delivers. We own the whole chain: the qualifying-stay check at intake, MDS-driven case-mix accuracy, the HIPPS tie-out, consolidated-billing carve-outs, and the appeal that overturns a level-of-care downgrade. Medicare Part A, Medicaid, and Medicare Advantage all run through one certified workflow, so every payer is billed to its own rules and its own filing clock, and we reconcile Medicaid patient liability monthly to catch short-pays the moment they post. Our Skilled Nursing Facility billing services back it with 99% first-pass clean claims, up to 40% fewer denials, and days in A/R under 25. A named account manager and a live dashboard keep every Part A day, denial, and dollar in plain view. Request a revenue review
Not learned on your remittances
Hire a Skilled Nursing Facility billing services provider that already lives inside PDPM and Medicare Advantage utilization management and you protect the fee-for-service margin that subsidizes your below-cost Medicaid days — that is the outcome we deliver from the first cycle.
We arrive fluent in case-mix logic, consolidated-billing exclusions, and Medicaid patient-liability reconciliation, so none of it is learned on your remittances. The claim HIPPS is tied back to the MDS every time, an interdisciplinary Triple-Check runs before billing, and level-of-care downgrades are appealed hard.
OWNEDOne named manager on your accountVISIBLEEvery claim and denial on a live dashboard98%Client-retention recordA general SNF billing company treats a facility like any other clinic and leaves earned acuity and reversible denials on the table.
Request a Revenue ReviewWhat changes hands
Outsource Skilled Nursing Facility billing to us and clinical care and census stay exactly where they belong while the revenue-cycle burden moves to a team that does only this.
One certified bench — not a single irreplaceable hire — carries each stay from admission to zero balance: eligibility, MDS-to-HIPPS integrity, consolidated-billing reconciliation, MA appeals, and monthly Medicaid reconciliation under one workflow, never split across vendors. That is the payoff of outsourcing Skilled Nursing Facility billing services: when a seasoned MDS-savvy biller resigns, the case-mix knowledge no longer walks out the door with them.
Skilled Nursing Facility billing services outsourcing converts a fragile in-house payroll into a predictable transaction-based cost that scales bed by bed and building by building — so you get more Part A days paid at full value, fewer downgrades left unchallenged, and a revenue cycle that does not wobble on a resignation. Ready to hand it off? Request a revenue review or call +1 888-502-0537.
STAYSCase-mix knowledge, when a biller resignsSCALESBed by bed and building by buildingSTEADYA cycle that does not wobbleWhere we bill
Billing rules, payer requirements and program structures vary by state. Explore our state pages for the programs, payers and billing considerations that matter in each market.
Looking at a specific market? We publish local billing detail city by city — payer mix, local programs, and the denial patterns we see there. Browse every state and city we serve.
Whether you run a single freestanding SNF, a hospital-based skilled unit, or a portfolio of buildings, our skilled nursing facility billing services protect every Part A day, every Medicare Advantage stay, and every dollar of aged A/R. Hand PDPM and MDS accuracy, consolidated billing, Medicare Advantage appeals, and Medicaid patient liability to a team that treats them as routine — and put the revenue your acuity has already earned back where it belongs.
Prefer email? sales@247medicalbillingservices.com