Skilled Nursing Facilities strive for quality of care, quality of life, helping residents return to the community and providing compassion for those who peacefully transition from this life.  While our jobs can be hard, caregivers would agree that the real excitement is in helping those who can’t help themselves!

One part of the job that is hard is the documentation, coding, and the billing.  We went to school to care for people, not to document, bill, and ensure claims are paid.  But if it’s not our responsibility as clinicians, then whose responsibility is it? Unfortunately, whether you like this answer or not, it is all of our responsibility!  Documentation that does not support medical necessity will result in denial of claims and need for appeal.

Working through the appeal process takes an immense amount of time and attention to detail, not to mention resources to track the process. We have to be committed as a team to ensure our claims are paid and the money remains in our pockets.

If an Additional Development Request (ADR) is made from the Medicare Contractor, ensure you have a denials/appeal team established in the SNF to tackle the layers of the process.  It is crucial to include all necessary documentation for the auditor to review.  Stopping a denial at the ADR level will preserve payments and avoid denials which could negatively affect facility cash flow and increase resources for resident care.

Your  therapy provider must be committed to transparency and working together with nursing to ensure that the nursing and therapy documentation supports medical necessity and reflects the skills of a nurse and therapist.  After all, we are committed to doing everything we can to improve the lives of our residents.  Being a part of a pro-active, transparent, and seamless team is vital to the success of the facility and is our commitment to you!

Gina Tomcsik

Director of Compliance